Gait Speed as an Incremental Predictor of Mortality and Major Morbidity in Elderly Patients Undergoing Cardiac Surgery

Afilalo, Jonathan; Eisenberg, Mark J.; Morin, Jean Francois; Bergman, Howard; Monette, Johanne; Noiseux, Nicolas; Perrault, Louis P.; Alexander, Karen P.; Langlois, Yves; Dendukuri, Nandini; Chamoun, Patrick; Kasparian, Georges; Robichaud, Sophie; Gharacholou, S. Michael; Boivin, Jean François

doi:10.1016/j.jacc.2010.06.039

Cited by 654 publications

(564 citation statements)

References 37 publications

(37 reference statements)

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“…Consistent with other reports,1, 13 sex was not an independent predictor of long‐term mortality in our pooled analysis. However, our adjusted Kaplan‐Meier plots (Figure 5) demonstrated a higher probability of long‐term survival in men <75 years of age and in women ≥75 years of age.…”

Section: Discussionsupporting

confidence: 93%

“…The European System for Cardiac Operation Risk Evaluation II has been shown to overestimate mortality in isolated patients undergoing CABG,40 whereas the Society of Thoracic Surgeons score underestimates it 13. However, the incorporation of a frailty score into such risk models has been shown to improve model discrimination 14, 23, 24.…”

Section: Discussionmentioning

confidence: 99%

“…Assessments of frailty can be made with clinical scales,22 functional assessments,13, 23 and their combination,24 or by the presence of a constellation of frailty‐defining diagnoses 5, 8, 25. This last method uses the Johns Hopkins Adjusted Clinical Groups (ACG) frailty‐defining diagnoses indicator, which is an instrument based on 10 clusters of frailty‐defining diagnoses (ie, malnutrition, dementia, impaired vision, decubitus ulcer, incontinence of urine, loss of weight, poverty, barriers to access to care, difficulty in walking, and falls; Table S1).…”

Section: Methodsmentioning

confidence: 99%

“…It is associated with increased mortality, surgical site infections, length of hospital stay, increased healthcare expenditure, and readmission rates in patients presenting for a variety of major noncardiac surgeries 8, 9, 10, 11, 12. Frailty has also been reported as a risk factor for mortality, major adverse cardiac and cerebrovascular events, and increased length of hospital stay in cardiac surgical patients 1, 2, 13, 14, 15, 16. The cardiac surgery literature consists primarily of relatively small single‐center studies with limited follow‐up durations, and the epidemiological features of frailty remain to be elucidated in long‐term follow‐up.…”

Section: Introductionmentioning

confidence: 99%

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Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

104

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BackgroundFrailty is increasing in prevalence and poses a formidable challenge for clinicians. The cardiac surgery literature consists primarily of small single‐center studies with limited follow‐up, and the epidemiological features of frailty remain to be elucidated in long‐term follow‐up.Methods and ResultsWe conducted a population‐based, retrospective, cohort study in Ontario, Canada, between 2008 and 2015. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator (a multidimensional instrument validated for research using administrative data). The primary outcome was mortality. Mortality rates were calculated using the Kaplan‐Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model. Of 40 083 patients, 8803 (22%) were frail. At 4±2 years of follow‐up, age‐ and sex‐standardized mortality rate per 1000 person‐years was higher in frail (33; 95% confidence interval, 29–36) compared with nonfrail (22; 95% confidence interval, 19–24) patients. Frailty was associated with an increased risk of long‐term mortality (adjusted hazard ratio, 1.20; 95% confidence interval, 1.12–1.28) and greater differences in the survival of patients between 40 and 74 years of age than in those who were ≥85 years old.ConclusionsFrailty was present in a large proportion of patients undergoing coronary artery bypass grafting and was independently associated with long‐term mortality. The adjusted risk of frailty‐related death was inversely proportional to age. Our findings highlight the need for more comprehensive preoperative risk stratification models to assist with optimal selection of operative candidates. In addition, we identified the <75 years age group as a potential target for comprehensive preoperative optimization programs, such as cardiac prehabilitation, nutritional augmentation, and psychosocial support.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

104

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“…For inoperable patients the emergence of trans-catheter aortic valve implantation (TAVI) profoundly changed the life expectancy of high-risk patients [7,8]. In the last decade, TAVI has been performed in about 150,000 patients worldwide and indications keep growing at a rate of 40% annually.…”

Section: Introductionmentioning

confidence: 99%

The Treatment of Aortic Valve Stenosis in Patients at Intermediate-High Risk

Nardi¹,

Russo²

2016

Interv Cardiol J

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Aortic valve stenosis (AS) is the most common valvular pathology in the elderly with an estimated prevalence of 4.6% in patients older than 75 years. Most of the patients remain asymptomatic for decades and when they develop symptoms, the prognosis became drastically poor with an estimated mortality of 50% in two years without surgical treatment. Aortic valve replacement (AVR) represents the gold standard for treatment of patients affected by aortic valve stenosis. Introduced in 1960s, AVR is associated with excellent long-term outcomes and low perioperative mortality and morbidity. With the aging of population, number of patients with AS increased progressively and the typical patient's profile has become more and more complex with more associated pathology and higher surgical risk. In this complex scenario the introduction of transcatheter aortic valve implantation (TAVI) has profoundly altered the landscape of cardiovascular medicine.

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Gait Speed in Hospitalized Older People

Studenski¹

2012

Arch Intern Med

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Ostir et al provide compelling evidence that simple performance measures of function, like gait speed, are powerful indicators of important health care outcomes, even in acutely ill older persons. 1 Much of the prior work on performance measures was based in community dwelling older populations, where the assumption that performance measures were reliable in medically stable people was central to assumptions about predictive ability. Ostir shows that performance measures in acutely ill, medically unstable older adults retain their ability to provide important clinical information.Building on an ever-expanding evidence base, it is now unequivocally clear that in order to understand and manage the health care needs, prognosis, and outcomes of older adults, we must incorporate indicators of function. 2,3 Since most older adults suffer from multiple interacting health conditions, it is simply insufficient to base services on only diseasespecific guidelines and outcomes. 4

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Gait Speed as an Incremental Predictor of Mortality and Major Morbidity in Elderly Patients Undergoing Cardiac Surgery

Abstract: Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery.

Cited by 654 publications

References 37 publications

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

The Treatment of Aortic Valve Stenosis in Patients at Intermediate-High Risk

Gait Speed in Hospitalized Older People

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