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Additional file 1. Interview guide.

Additional file 2. Themes and quotes examples.

Tan Van Nguyen,1,2 Duong Le,1,2 Khuong Dang Tran,1 Khai Xuan Bui,1 Tu Ngoc Nguyen3 1Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; 2Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam; 3Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaCorrespondence: Tan Van NguyenDepartment of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, VietnamTel +84 903 739 273Email nguyenvtan10@ump.edu.vnBackground: There has been limited evidence about frailty in older patients with acute coronary syndrome (ACS) in Vietnam.Aim: (1) To investigate the prevalence of frailty in older patients hospitalised with ACS and its associated factors; (2) To investigate the impact of frailty on percutaneous coronary intervention (PCI) and adverse outcomes in this population.Methods: Patients aged ≥60 with ACS admitted to two teaching hospitals in Vietnam were recruited from 9/2017 to 4/2018. Frailty was defined by the Reported Edmonton Frail Scale. Multivariate logistic regression was applied to investigate the associated factors of frailty and the impact of frailty on PCI and adverse outcomes.Results: There were 324 participants, mean age 73.5±8.3, 39.2% female. The prevalence of frailty was 48.1%. Advanced age, female gender, history of hypertension, heart failure, stroke and chronic kidney disease were significantly associated with a frailty status. Overall, 50.3% of the participants received PCI (58.3% in the non-frail vs 41.7% in the frail, p=0.003). However, frailty did not have an independent impact on PCI (adjusted OR 0.66, 95% CI 0.41–1.08). Frailty was significantly associated with increased risk of having arrhythmia during hospitalisation (adjusted OR 2.24, 95% CI 1.32–3.80), hospital-acquired pneumonia (adjusted OR 2.27, 95% CI 1.24–4.17), in-hospital mortality (adjusted OR 3.02, 95% CI 1.35–6.75), 30-day mortality (adjusted OR 3.28, 95% CI 1.59–6.76), and 30-day readmission (adjusted OR 2.53, 95% CI 1.38–4.63).Conclusion: In this study, frailty was present in nearly half of older patients with ACS and was associated with increased adverse outcomes. These findings suggest that frailty screening should be performed in older patients with ACS in Vietnam.Keywords: frailty, acute coronary syndrome, elderly, older patients, adverse outcomes, Vietnam

Tam Ngoc Nguyen,1,2 Anh Trung Nguyen,1,2 Long Quynh Khuong,3 Thanh Xuan Nguyen,1,2 Huong Thi Thu Nguyen,1,2 Thu Thi Hoai Nguyen,1,2,4 Minh Van Hoang,3 Thang Pham,1,2 Tu Ngoc Nguyen,5 Huyen Thi Thanh Vu1,6 1Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam; 2Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam; 3Hanoi University of Public Health, Hanoi, Vietnam; 4Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 5Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; 6Hanoi Medical University Hospital, Hanoi, VietnamCorrespondence: Huyen Thi Thanh VuDepartment of Geriatrics, Hanoi Medical University, 01 Ton That Tung, Dong Da, Hanoi, VietnamTel +84913531579Email vuthanhhuyen11@hmu.edu.vnBackground: The SARC-F questionnaire has been developed as a rapid diagnostic test that can be used to screen for sarcopenia.Aim: To investigate the reliability and validity of the Vietnamese version of SARC-F as a screening tool for sarcopenia in older patients in Vietnam.Methods: A cross-sectional study was conducted in older people attending the outpatient clinics of the National Geriatric Hospital in Vietnam. Muscle mass (using dual-energy X-ray absorptiometry), handgrip strength and gait speed were assessed. SARC-F was validated against the three standard criteria for sarcopenia: the Foundation for the National Institutes of Health (FNIH), Asia Working Group for Sarcopenia (AWGS 2019) and European Working Group on Sarcopenia in Older People (EWGSOP2).Results: There were 764 participants (mean age 71.5 ± 8.9 years). The Vietnamese SARC-F questionnaire had a good internal consistency (Cronbach’s alpha 0.85). The prevalence of sarcopenia was 49.2% according to SARC-F and 48.3%, 61.1% and 52.6% according to FNIH, AWGS 2019 and EWGSOP2, respectively. The sensitivity and specificity of SARC-F in identifying sarcopenia were 67.1% and 66.7% (for FINH), 66.7% and 67.1% (for AWGS 2019), and 64.9% and 68.2% (for EWGSOP2). The AUCs of SARC-F were 0.71– 0.72 against the three sarcopenia criteria.Conclusion: The Vietnamese version of SARC-F questionnaire has acceptable diagnostic value for sarcopenia. SARC-F could be used as an initial screening for sarcopenia in hospital clinics.Keywords: older patients, sarcopenia, SARC-F, Vietnam

OBJECTIVES: We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study. METHODS: We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types were available and affordable, group 2-all three drugs were available but not affordable and group 3-all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors. RESULTS: Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50). CONCLUSION: Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.