The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery

Abstract

Background The Essential Frailty Toolset (EFT) was shown to be easy to use and predictive of adverse events in patients undergoing aortic valve replacement procedures. The objective of this study was to evaluate the EFT in patients undergoing coronary artery bypass grafting procedures. Methods and Results The McGill Frailty Registry prospectively included patients ≥60 years of age undergoing urgent or elective isolated coronary artery bypass grafting between 2011 and 2018 at 2 hospitals. The preoperative EFT was scored 0 to 5 points as a function of timed chair rises, Mini‐Mental Status Examination, serum albumin, and hemoglobin. The primary outcome was all‐cause mortality assessed by Cox proportional hazards regression. The cohort consisted of 500 patients with a mean age of 71.4 ± 6.4 years, of which 27% presented with acute coronary syndromes requiring urgent surgery. The mean EFT was 1.3 ± 1.1 points, 132 (26%) were nonfrail, 298 (60%) were prefrail, and 70 (14%) were frail. Over a median follow‐up of 4.0 years, 78 deaths were observed. In nonfrail, prefrail, and frail patients, survival at 1 year was 98%, 95%, and 91%, and at 5 years was 89%, 83%, and 63% ( P <0.001). After adjustment, each incremental EFT point was associated with a hazard ratio of 1.28 (95% CI, 1.05–1.56) and frail patients had a 3‐fold increase in all‐cause mortality. Conclusions The EFT is a pragmatic and highly prognostic tool to assess frailty and guide decisions for coronary artery bypass grafting in older adults. Furthermore, the EFT may be actionable through targeted interventions such as cardiac rehabilitation and nutritional optimization.

Management of Hypertension in the Elderly and Frail Patient

“…Moreover, the comprehensive geriatric assessment or multidimensional approaches are more representative of global complexity assessment, though time consuming [13][14][15][16]. Short multidimensional approaches such as the Essential Frailty Toolset have been shown to have an additive predictive value in specific cardiovascular diseases such as aortic stenosis or cardiac surgery [17,18] and are becoming popular, particularly in the general cardiology ambulatory setting, due to their feasibility.…”

Comparing health outcomes between coronary interventions in frail patients aged 75 years or older with acute coronary syndrome: a systematic review

“…The Hospital Frailty Risk Score (HFRS) used by Kwok et al [ 22 ] was developed and validated using broadly representative hospitalized cohorts [ 29 ]. Wong, Lee, and El-Jack [ 23 ] used the Essential Frailty Toolset (EFT) [ 30 , 31 ], which has been validated in older patients undergoing transcatheter aortic valve implantation and was recently used in a study of older patients who underwent CABG [ 30 ]. Llao et al [ 19 ] used the FRAIL scale [ 32 ], which has been validated against the Fried score [ 33 ], and has been shown to predict mortality risk in older ACS patients [ 34 ].…”

Digital health in older adults for the prevention and management of cardiovascular diseases and frailty. A clinical consensus statement from the ESC Council for Cardiology Practice/Taskforce on Geriatric Cardiology, the ESC Digital Health Committee and the ESC Working Group on e‐Cardiology

“…One example is the Frailty Tool mApp (frailtytool.com) that integrates the Essential Frailty Toolset (EFT) alongside the Society of Thoracic Surgeons risk score to guide decision making in older adults referred for transcatheter aortic valve replacement (TAVR) or cardiac surgery. In addition to prognostic value, 88,89 therapeutic value has been demonstrated by de-frailing patients with high EFT score using prehabilitation and multicomponent geriatric intervention. 90,91 In daily clinical practice, general cardiologists are increasingly using DH tools for the management of deficits associated with older-age (Figure 2).…”