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Objective: Older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS) require holistic assessment. We carried out a longitudinal cohort study to investigate health-related quality of life (HRQoL) of older, frail adults with NSTEACS undergoing coronary angiography.Methods: 217 consecutive patients aged ≥65 years (mean age 80.9±4.0 years, 60.8% male) with NSTEACS referred for coronary angiography were recruited from two tertiary cardiac centres between November 2012 and December 2015. Frailty was assessed with the Fried Frailty Index; a score of 0 was characterised as robust, 1-2 prefrail and ≥3 frail. The Short Form Survey 36 (SF-36), an HRQoL tool consisting of eight domains spanning physical and mental health, was performed at baseline and 1 year.Results: 186 patients (85.7%) had invasive revascularisation. At baseline, 52 (23.9%) patients were frail and 121 (55.8%) were prefrail, with most SF-36 domains falling below the norm-population mean. Patients with frailty had lower mean scores in all physical SF-36 domains (p≤0.05) compared with those without frailty. Robust patients had temporal improvement in two domains (role physical +5.80 (95% CI 1.31 to 10.3) and role emotional +6.46 (95% CI 1.02 to 11.9)) versus patients with frailty and prefrailty, who had a collective improvement in a greater number of physical and psychological domains at 1 year (2 domains vs 11 domains), notably role physical (prefrail +6.53 (95% CI 3.85 to 9.20) and frail +10.4 (95% CI 6.7814.1)).Conclusions: Frail older adults with NSTEACS have poor HRQoL. One year following invasive management, there are modest improvements in HRQoL, most marked in frail and prefrail patients, who received a proportionally larger benefit than robust patients.Trial Registration Number: NCT01933581. [ABSTRACT FROM AUTHOR]

Objective: To study the survival and patient outcome in a population of UK patients supported by an implantable left ventricular assist device (LVAD) as a bridge to heart transplantation.Methods: Data on all adult patients (n=342) who received a HeartMate II or HVAD as a first long-term LVAD between January 2007 and 31 December 2013 were extracted from the UK Ventricular Assist Device (VAD) Database in November 2015. Outcomes analysed include survival on a LVAD, time to urgent listing, heart transplantation and complications including those needing a pump exchange.Results: 112 patients were supported with the Thoratec HeartMate II and 230 were supported with the HeartWare HVAD. Median duration of support was 534 days. During the study period, 81 patients required moving to the UK urgent waiting list for heart transplantation. Of the 342 patients, 85 (24.8%) received a heart transplant, this included 63 on the urgent list. Thirty-day survival was 88.9%, while overall patient survival at 3 years from LVAD implant was 49.6%. 156 patients (46%) died during LVAD support; the most common cause of death on a VAD was a cerebrovascular accident. There was no significant difference between the two devices used in any outcome.Conclusions: In a population of patients with advanced heart failure, who have a very poor prognosis, support with an implantable LVAD allowed a quarter to receive a heart transplant in a 3-year period. Overall survival of the cohort was about 50%. With improvement in technology and in post-LVAD management, it is likely that outcomes will improve further. [ABSTRACT FROM AUTHOR]