The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery

Ad, Niv; Holmes, Sari D.; Halpin, Linda; Shuman, Deborah J.; Miller, Casey; Lamont, Deborah

doi:10.1111/jocs.12699

Cited by 45 publications

(65 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We identified 25 studies that evaluated the association of frailty with mortality or functional status at ≥6 months in 18388 patients undergoing major cardiac surgical procedures (9 frailty instruments in 8 studies of CABG or open valve surgery)(41-49) and 5177 patients undergoing minimally invasive cardiac surgical procedures (13 instruments in 17 studies of TAVR)(11-15, 50-61) (Appendix Figure 1). …”

Section: Resultsmentioning

confidence: 99%

“…There were 5 multi-component frailty instruments that required information from self-report or medical records alone(46, 47) (administration time <5 minutes) or administration of performance tests(41, 48, 49) (up to 20 minutes). Frequently included components were mobility (4 instruments) and disability (4 instruments).…”

Section: Resultsmentioning

confidence: 99%

“…Such association was not found for the Cervera index and frailty phenotype due to simultaneous adjustment for other frailty markers(47) or insufficient power. (49) None of the studies examined functional status. All 4 studies of multi-component instruments were conducted in single-center samples (Appendix Figure 2 panel A) and only Lee et al evaluated the model performance after accounting for overfitting.…”

Section: Resultsmentioning

confidence: 99%

“…Although widely validated frailty phenotype(17) predicted mortality and MACCE after TAVR,(59) this finding was not consistent in other studies. (49, 54) The deficit accumulation frailty index is another validated frailty instrument,(18, 67) but its association with clinical outcomes has not been tested in patients undergoing cardiac surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

et al. 2016

View full text Add to dashboard Cite

Background Frailty assessment may inform surgical risk and prognosis that are not captured by conventional surgical risk scores. Purpose To evaluate the evidence for various frailty instruments to predict mortality, functional status, or major adverse cardiovascular and cerebrovascular events (MACCE) in older adults undergoing cardiac surgical procedures. Data Sources MEDLINE and EMBASE (without language restrictions), from their inception to May 2, 2016. Study Selection Cohort studies that evaluated the association of frailty with mortality or functional status at ≥6 months in patients aged ≥60 years undergoing major or minimally invasive cardiac surgical procedures. Data Extraction Two reviewers independently extracted study data and assessed study quality. Data Synthesis Mobility, disability, and nutrition were frequently assessed domains of frailty in both types of procedures. In patients undergoing major procedures (N=18388, 8 studies), 9 frailty instruments were evaluated. There was moderate-quality evidence to assess mobility or disability and very-low-to-low-quality evidence to use a multi-component instrument to predict mortality or MACCE. No studies examined functional status. In patients undergoing minimally invasive procedures (N=5177, 17 studies), 13 frailty instruments were evaluated. There was moderate-to-high-quality evidence to assess mobility to predict mortality or functional status. Several multi-component instruments predicted mortality, functional status, or MACCE, but the quality of evidence was low to moderate. Multi-component instruments that measure different frailty domains seemed to outperform single-component instruments. Limitations Heterogeneity of frailty assessment, limited generalizability of multi-component frailty instruments, few validated frailty instruments, and potential publication bias. Conclusions Frailty status, assessed by mobility, disability, and nutritional status, can predict mortality at 6 months or later after major cardiac surgical procedures and functional decline after minimally invasive cardiac surgical procedures. Primary Funding Source National Institute on Aging and National Heart, Lung, and Blood Institute; there was no registration for this review.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The increased use of LVADs and extracorporal mechanical support (ECMO) has prompted interest in determining which groups of patients are more prone to increased perioperative complications and may not benefit from this more aggressive support . While frailty has been identified as a potential risk factor for poor long‐term survival, frailty alone may not identify patients at increased risk for adverse outcomes following cardiac surgical procedures . In addition, the effects of obesity have also been studied in LVAD patients, but BMI itself may not be an independent predictor of overall survival .…”

Section: Discussionmentioning

confidence: 99%

Predictive value of preoperative serum albumin levels on outcomes in patients undergoing LVAD implantation

et al. 2018

View full text Add to dashboard Cite

show abstract

Comparison of Multidimensional Frailty Instruments for Estimation of Long-term Patient-Centered Outcomes After Cardiac Surgery

et al. 2022

View full text Add to dashboard Cite

IMPORTANCELittle is known about the performance of available frailty instruments in estimating patient-relevant outcomes after cardiac surgery. OBJECTIVE To examine how well the Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator, the Hospital Frailty Risk Score (HFRS), and the Preoperative Frailty Index (PFI) estimate long-term patient-centered outcomes after cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in Ontario, Canada, among residents 18 years and older who underwent coronary artery bypass grafting or aortic, mitral or tricuspid valve, or thoracic aorta surgery between October 2008 and March 2017.Long-term care residents, those with discordant surgical encounters, and those receiving dialysis or dependent on a ventilator within 90 days were excluded. Statistical analysis was conducted from July 2021 to January 2022. MAIN OUTCOMES AND MEASURESThe primary outcome was patient-defined adverse cardiovascular and noncardiovascular events (PACE), defined as the composite of severe stroke, heart failure, long-term care admission, new-onset dialysis, and ventilator dependence. Secondary outcomes included mortality and individual PACE events. The association between frailty and PACE was examined using cause-specific hazard models with death as a competing risk, and the association between frailty and death was examined using Cox models. Areas under the receiver operating characteristic curve (AUROC) were determined over 10 years of follow-up for each frailty instrument. RESULTSOf 88 456 patients (22 924 [25.9%] female; mean [SD] age, 66.3 [11.1] years), 14 935 (16.9%) were frail according to ACG criteria, 63 095 (71.3%) according to HFRS, and 76 754 (86.8%) according to PFI. Patients with frailty were more likely to be older, female, and rural residents; to have lower income and multimorbidity; and to undergo urgent surgery. Patients meeting ACG criteria (hazard ratio [HR], 1.66; 95% CI, 1.60-1.71) and those with higher HFRS scores (HR per 1.0-point increment, 1.10; 95% CI, 1.09-1.10) and PFI scores (HR per 0.1-point increment, 1.75; 95% CI, 1.73-1.78) had higher rates of PACE. Similar magnitudes of association were observed for each frailty instrument with death and individual PACE components. The HFRS had the highest AUROC for estimating PACE during the first 2 years and death during the first 4 years, after which the PFI had the highest AUROC. CONCLUSIONS AND RELEVANCEThese findings could help to tailor the use of frailty instruments by outcome and follow-up duration, thus optimizing preoperative risk stratification, patient-centered decision-making, candidate selection for prehabilitation, and personalized monitoring and health resource planning in patients undergoing cardiac surgery.

show abstract

The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery

Cited by 45 publications

References 18 publications

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

Predictive value of preoperative serum albumin levels on outcomes in patients undergoing LVAD implantation

Comparison of Multidimensional Frailty Instruments for Estimation of Long-term Patient-Centered Outcomes After Cardiac Surgery

Contact Info

Product

Resources

About