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Identifying frailty trajectories in older patients with acute myocardial infarction using structural entropy
Tongtong Zhang1, Haoran Yang2, Xiaoping Lou3
1Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Longhu Zhonghuan Road, Zhengzhou, Henan, 450052, China.
Background:
Frailty significantly complicates clinical outcomes in older adults with acute myocardial infarction, yet its progression is dynamic and heterogeneous. This study aimed to identify distinct frailty trajectory patterns and their predictors using a machine learning approach, to support evidence-based nursing interventions.
Methods:
A prospective cohort study was conducted, enrolling 583 older adults with acute myocardial infarction hospitalized between March 2023 and March 2024. We collected multidimensional clinical, physiological, psychological, and functional data at six time points over a one-year follow-up period. A patient similarity network was constructed from these longitudinal data, and the Structural Entropy Clustering algorithm was employed to identify frailty trajectory groups. Group differences were analyzed using ANOVA and Tukey's post hoc tests, while multinomial logistic regression was used to determine key predictors of trajectory membership.
Results:
Four distinct frailty trajectories were identified: "Rapidly Worsening Frailty" ([Formula: see text], 13.4%), "Stable Non-Frail" ([Formula: see text], 44.7%), "Slowly Progressive Frailty" ([Formula: see text], 37.4%), and "Improving Frailty" ([Formula: see text], 4.5%). Significant differences were observed among the groups in functional status, psychological scores, nutritional status, left ventricular ejection fraction, and Charlson Comorbidity Index ([Formula: see text]). Multivariate analysis revealed that lower functional status (Modified Barthel Index per 10-point decrease: [Formula: see text], 95% CI: 7.37-11.82, [Formula: see text]) and advanced age ([Formula: see text], [Formula: see text]) were strong predictors for the "Rapidly Worsening Frailty" trajectory, while psychological factors including anxiety ([Formula: see text], [Formula: see text]) and depression ([Formula: see text], [Formula: see text]) were significant predictors for the "Slowly Progressive Frailty" trajectory.
Conclusions:
Frailty progression following acute myocardial infarction is heterogeneous, and distinct trajectory patterns can be identified using structural entropy clustering. These findings may support the development of differentiated nursing strategies for early identification of high-risk individuals, pending validation in multicenter settings.
