Format

Send to

Choose Destination
J Thorac Cardiovasc Surg. 2017 Dec;154(6):1990-1999. doi: 10.1016/j.jtcvs.2017.06.040. Epub 2017 Jun 24.

The impact of frailty on functional survival in patients 1 year after cardiac surgery.

Author information

1
Institute of Cardiovascular Sciences, St Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada.
2
Institute of Cardiovascular Sciences, St Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada; Health, Leisure, and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
3
Seven Oaks Hospital and University of Manitoba, Winnipeg, Manitoba, Canada.
4
Institute of Cardiovascular Sciences, St Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada; Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: rakeshcarora@gmail.com.

Abstract

OBJECTIVE:

This study determined whether frailty provides incremental value to the European System for Cardiac Operative Risk Evaluation II in identifying patients at risk of poor 1-year functional survival.

METHODS:

This prospective study in patients undergoing cardiac surgery defined frailty using 3 common definitions: (1) the Modified Fried Criteria; (2) the Short Physical Performance Battery; and (3) the Clinical Frailty Scale. The primary outcome was functional survival, defined as being alive at 1 year postsurgery with a health-related quality of life score greater than 60 on the EuroQol-Visual Analogue Scale.

RESULTS:

Of the 188 participants, 49.5%, 52.6%, and 31.9% were deemed frail according to the Modified Fried Criteria, Short Physical Performance Battery, and Clinical Frailty Scale, respectively. The median age of our cohort was 71.0 years (29.3% female). The probability of functional survival at 1 year for the entire cohort was 73.9%. After adjusting for the European System for Cardiac Operative Risk Evaluation II, patients deemed frail under the Modified Fried Criteria, Short Physical Performance Battery, and Clinical Frailty Scale had an increased odds ratio for poor functional survival of 3.44, 3.47, and 2.08, respectively. When compared with the European System for Cardiac Operative Risk Evaluation II alone, the Modified Fried Criteria, Short Physical Performance Battery, and Clinical Frailty Scale showed an absolute improvement in the discrimination slope of 6.7%, 6.5%, and 2.4% with a category-free classification improvement of 59.6%, 59.2%, and 35.1%, respectively.

CONCLUSIONS:

Preoperative frailty was associated with a 2- to 3.5-fold higher risk of poor functional survival 1 year after cardiac surgery. The addition of frailty to the European System for Cardiac Operative Risk Evaluation II provides incremental value in identifying patients at risk of poor functional survival 1 year postsurgery, regardless of frailty definition.

KEYWORDS:

HRQoL; cardiac surgery; frailty; long-term outcomes; survival

Comment on

PMID:
28734627
DOI:
10.1016/j.jtcvs.2017.06.040
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center