Rapid Bedside Frailty Assessment and Cardiac Surgery Outcomes: A Pilot Study (original) (raw)
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Journal of Cardiothoracic and Vascular Anesthesia, 2019
Objectives: To investigate whether the Edmonton Frail Scale, a multidimensional frailty assessment tool, improves the prediction of 30-day or in-hospital mortality over the use of the EuroSCORE II alone. Design: Single-center prospective observational study. Setting: University Hospital Participants: Patients aged of 75 years or older undergoing cardiac surgery between February 2014 and May 2017. Intervention: No intervention was performed. The Edmonton Frail Scale (EFS) was administered the day before surgery. Measurements and Main Results: The primary endpoint was 30-day or in-hospital mortality. Secondary endpoints were times to discharge from the intensive care and from the hospital, discharge to a healthcare facility and ability to return home by post-operative day 30. The EFS had a good discriminative ability for 30-day mortality (area under the receiver operating characteristic (ROC) curve=0.69; 95%CI, 0.56-0.82). Adding frailty, defined by an EFS ≥ 8, to the EuroSCORE II significantly improved the prediction of 30-day (P=0.04) mortality. The integrated discrimination index (IDI) was 0.03 (95%CI, 0.01-0.06, P=0.01), meaning that the difference in predicted risk between patients who died and those who survived increased by 3 % thanks to the addition of frailty determined by the EFS to the EuroSCORE II. Frailty was also significantly associated with a decreased cumulative probability of discharge from ICU (P=0.02) and an increased incidence of discharge to a healthcare facility (P=0.01). Conclusion: The Edmonton Frail Scare has a good predictive ability for 30-day mortality after cardiac surgery in elderly patients and improves the prediction of 30-day mortality over the use of the EuroSCORE II.
Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery☆
European Journal of Cardio-Thoracic Surgery, 2011
Objective: Cardiosurgical operative risk can be assessed using the logistic European system for cardiac operative risk evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score. Factors other than medical diagnoses and laboratory values such as the 'biological age' are not included in these scores. The aim of the study was to evaluate an additional assessment of frailty in routine cardiac surgical practice. Methods: 'The comprehensive assessment of frailty' test was applied to 400 patients !74 years who were admitted to our centre between September 2008 and January 2010. For comparison, the STS score and the EuroSCORE were calculated. The primary end point was the correlation of Frailty score to 30-day mortality. A total of 206 female and 194 male patients were included. Results: Median Frailty score was 11 . Median of logistic EuroSCORE was 8.5% [5.8%; 13.9%]. Median of STS score was 3.3% [2.1%; 5.1%]. There were low-to-moderate albeit significant correlations of Frailty score with STS score and EuroSCORE ( p < 0.05). There was also a significant correlation between Frailty score and observed 30-day mortality ( p < 0.05). Patients received isolated coronary artery bypass grafting (CABG) (n = 90), isolated valve surgery (n = 128), trans-catheter valve implantation (n = 59) or combined procedures (n = 123). Conclusions: The comprehensive assessment of frailty is an additional tool to evaluate elderly patients adequately before cardiac surgical interventions. The Frailty score combines characteristics of the Fried criteria [1], of patient phenotype, of his physical performance and laboratory results. Further analysis on a larger patient population is warranted. A combination of the new Frailty score and the traditional scoring systems may facilitate a more accurate risk scoring in elderly high-risk patients scheduled for conventional cardiac surgery or trans-catheter aortic valve replacement. #
Systematic review on the predictive ability of frailty assessment measures in cardiac surgery
Interactive cardiovascular and thoracic surgery, 2017
Patient frailty is increasingly recognised as contributing to adverse postoperative outcomes in cardiothoracic surgery. The goal of this review is to evaluate the predictive ability of frailty scoring systems and their limitations in risk assessment of patients undergoing cardiac surgery. Frailty studies were identified by searching electronic databases. Studies in which the measuring instrument was defined as a multidimensional tool focusing on a population undergoing cardiac operations were included. The focus was on the predictive ability of frailty in this population and a comparison with conventional risk scoring systems. Unfortunately, the lack of a significant number of studies with the same postoperative outcome precluded a formal meta-analysis. Of 783 studies identified in our initial search, 6 fulfilled our inclusion criteria. Frailty was identified as a predictor of mortality, morbidity and/or prolonged hospital stay in patients undergoing cardiac surgery. Our systematic ...
Role of frailty assessment in patients undergoing cardiac interventions
Open heart, 2014
Average life expectancy is increasing in the western world resulting in a growing number of frail individuals with coronary heart disease, often associated with comorbidities. Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications. Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality. Frailty assessment has emerged as a measure of biological age that correlates well with quality of life, hospital admissions and mortality. Potentially, the incorporation of frailty into current risk assessment models will cause a shift towards more appropriate care. T...
JAMA Network Open
IMPORTANCE Little 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 MEASURES The 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. RESULTS Of 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 RELEVANCE These 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.
Assessment and Utility of Frailty Measures in Critical Illness, Cardiology, and Cardiac Surgery
Canadian Journal of Cardiology, 2016
Frailty is a multi-dimensional syndrome of loss of homeostatic reserves giving rise to vulnerability to adverse outcomes. Frailty is a emerging theme in critical care, cardiology and cardiac surgery with important prognostic implications. Routine screening for frailty conceivably has numerous potential benefits for patients, providers and policy-makers, through better informed decisionmaking, prognosis for survival, risk of complications, recovery expectations, and resource utilization. This review discusses the measurement of frailty and its utility in these populations.
Frontiers in Public Health, 2016
The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.
Are frailty scales better than anesthesia or surgical scales to determine risk in cardiac surgery?
Korean journal of anesthesiology, 2017
In the last year there has been an increasing interest for using frailty scales for risk stratification of elderly patients undergoing major surgery. We planned to compare two frailty scales with risk scales already used in cardiac surgery, to study which of these scores have better prognostic value predicting postoperative outcome in open heart surgery. We conducted a prospective clinical trial, including 57 patients over 65 years. We calculated Cardiac Anesthesia Risk Evaluation score, EuroScore II, Clinical Frailty Scale, Edmonton Frail Scale for each patient and followed the postoperative complications, length of mechanical ventilation, length of stay in the intensive care unit and hospital, and in-hospital death related to these risk and frailty scores. Postoperative complications occurred in 25 patients (43.9%), while four patients (7%) died with multiple organ failure. All scales had low predictability for postoperative complications, but for length of mechanical ventilation ...
Interactive cardiovascular and thoracic surgery, 2011
Assessment of perioperative risk of elderly patients in cardiac surgery is demanding. Most of the commonly used cardiac surgery risk scores over-or underestimate individual risk. Therefore, we recently developed a 'frailty score', the comprehensive assessment of frailty (CAF) score that showed a good prediction of 30-day mortality. The aim of the study was to evaluate the ability of the new score predicting one-year outcome. CAF was preoperatively applied to 400 patients ≥ 74 years that were admitted to cardiac surgery between September 2008 and January 2010. For 213 of these patients one-year follow-up was assessed by telephone interview until April 2010. One hundred and ten male and 103 female patients were included. Twenty-five percent underwent isolated coronary revascularization, 35% isolated valve procedures and 26% underwent combined procedures. One-year mortality was 12.2%. Patients who died within one year had a median frailty score of 16 [5;33] compared to 11 [3;33...