Frailty is a predictor of short- and mid-term mortality after elective cardiac surgery independently of age

Sündermann, Simon H.; Dademasch, Anika; Seifert, Burkhardt; Biefer, Héctor Rodriguez Cetina; Emmert, Maximilian Y.; Walther, Thomas; Jacobs, Stephan; Mohr, Friedrich–Wilhelm; Falk, Volkmar; Starck, Christoph

doi:10.1093/icvts/ivu006

Cited by 116 publications

(116 citation statements)

References 23 publications

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“…A similar effect was observed by other authors, explained by the imbalance in homeostasis and increased individual vulnerability (mainly acute stresses) characteristic of the syndrome 18,29 .…”

Section: Discussionsupporting

confidence: 88%

Impacts of frailty on the negative health outcomes of elderly Brazilians

Barbosa¹,

Mansur

Colugnati

2017

Rev. bras. geriatr. gerontol.

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Objective: to verify the association between frailty and the occurrence of falls, hospitalization and death among Brazilian elderly persons. Methods: a representative sample of elderly persons from the city of Juiz de Fora, Minas Gerais, Brazil, who had been evaluated with regard to frailty, socio-demographic conditions and health in 2009, were reevaluated in terms of negative health outcomes between 2014 and 2015 (n=304). Results: The results revealed a greater incidence of falls, hospitalization, and death among frail elderly persons. The frail group also had an increased risk (1.5, crude estimate) of death during the follow-up period than the robust individuals. The pre-frail elderly had a 55% (crude) and 58% (adjusted) greater risk of falls, and an 89% (crude) greater risk of death than robust individuals. Conclusion: frailty, as well as pre-frailty, can increase the risk of adverse events in the health of the elderly.

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Section: Discussionsupporting

confidence: 88%

Impacts of frailty on the negative health outcomes of elderly Brazilians

Barbosa¹,

Mansur

Colugnati

2017

Rev. bras. geriatr. gerontol.

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“…Frailty assessment may improve prognostication and explain functional limitations and disability that appear to be out of proportion to pulmonary impairment. Recent studies have shown that preoperative frailty and sarcopenia are associated with postoperative complications and mortality after major surgery (88)(89)(90)(91)(92). Measuring frailty in adults with lung disease preparing to undergo surgery-a group already at heightened risk for complications-could further improve risk stratification.…”

Section: Focused Reviewsmentioning

confidence: 99%

Frailty in Pulmonary and Critical Care Medicine

Singer

Lederer²,

Baldwin

2016

Annals ATS

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Conceptualized first in the field of geriatrics, frailty is a syndrome characterized by a generalized vulnerability to stressors resulting from an accumulation of physiologic deficits across multiple interrelated systems. This accumulation of deficits results in poorer functional status and disability. Frailty is a "state of risk" for subsequent disproportionate declines in health status following new exposure to a physiologic stressor. Two predominant models have emerged to operationalize the measurement of frailty. The phenotype model defines frailty as a distinct clinical syndrome that includes conceptual domains such as strength, activity, wasting, and mobility. The cumulative deficit model defines frailty by enumerating the number of age-related things wrong with a person. The biological pathways driving frailty include chronic systemic inflammation, sarcopenia, and neuroendocrine dysregulation, among others. In adults with chronic lung disease, frailty is independently associated with more frequent exacerbations of lung disease, all-cause hospitalization, declines in functional status, and all-cause mortality. In addition, frail adults who become critically ill are more likely develop chronic critical illness or severe disability and have higher in-hospital and long-term mortality rates. The evaluation of frailty appears to provide important prognostic information above and beyond routinely collected measures in adults with chronic lung disease and the critically ill. The study of frailty in these populations, however, requires multipronged efforts aimed at refining clinical assessments, understanding the mechanisms, and developing therapeutic interventions.Keywords: frailty; body composition; disability; health-related quality of life; mortality Correspondence and requests for reprints should be addressed to Jonathan P. Singer, M.D., M.S.,

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“…15) Furthermore, it was also identified as an independent predictor of increased morbidity and mortality after elective cardiac surgery. 16) Minimally invasive methods including transcatheter aortic valve replacement have been proposed to decrease postoperative mortality in these high risk and frail patients 17) by limiting the surgical stress of the operation. However, as recent meta-analyses show, controversy still remains, whether these techniques can really improve survival.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcome of High-Risk Octogenarians Undergoing Cardiac Surgery: A Multicenter Observational Retrospective Study

Pořízka

Kunstýř

Vanek

et al. 2017

ATCS

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Purpose: Cardiac surgery in octogenarians with severely deteriorated functional status is increasingly common, but outcome data are still limited. The aim of this study was to compare postoperative outcome, survival, and quality of life of low-, medium-, and highrisk octogenarians undergoing cardiac surgery. Methods: In all, 285 Czech octogenarians who underwent any cardiac surgical procedure between January 2011 and December 2012 were included in the study. Five out of all twelve national adult cardiac surgical centers participated in the study, representing almost half of all octogenarians operated in our country in that period. Patients' perioperative data were analyzed retrospectively. Follow-up was performed by interviewing patients by telephone. Results: There was higher 30-day mortality (20% vs. 6.4% vs. 5.2%, respectively, p <0.001), lower 2-year survival (60% vs. 84.0% vs. 85.4%, respectively, p <0.05), and lower Karnofsky score (44.4 vs. 70.1 vs. 70.6, respectively, p <0.001) in high-risk group compared with medium-and low-risk groups, respectively. Greater improvement in New York Heart Association (NYHA) status was noted in high-and medium-risk groups compared with low-risk group (51% vs. 45% vs. 24%, respectively, p <0.05). Conclusion: High perioperative mortality, poor 2-year survival, and low postoperative quality of life have been observed in high-risk octogenarians undergoing cardiac surgery.

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Frailty is a predictor of short- and mid-term mortality after elective cardiac surgery independently of age

Abstract: CAF and FORECAST are additional tools to evaluate elderly patients adequately before elective cardiac surgery, and showed an association with short- and mid-term mortality independently of age.

Cited by 116 publications

References 23 publications

Impacts of frailty on the negative health outcomes of elderly Brazilians

Impacts of frailty on the negative health outcomes of elderly Brazilians

Frailty in Pulmonary and Critical Care Medicine

Postoperative Outcome of High-Risk Octogenarians Undergoing Cardiac Surgery: A Multicenter Observational Retrospective Study

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