Prognostic role of frailty in early and long-term prognosis after coronary artery bypass grafting

Close metadata

OBJECTIVE. T

O assess the role of frailty in complications and adverse outcomes after coronary artery bypass grafting (CABG) in early and long-term follow-up period considering the diagnostic algorithm presented in the Russian clinical guidelines on frailty.

MATERIAL AND METHODS

The study included 387 coronary artery disease (CAD) patients admitted for CABG. A multistage algorithm including a questionnaire “Age is not a drawback”, short test battery for assessing physical functioning and brief cognitive screening test (Mini-Cog) was used to diagnose prefrailty and frailty in patients. Statistical analysis was carried out using the IBM SPSS Statistics software (ver. 26.0.0). Differences were significant at p<0.05.

RESULTS

The prevalence of frailty in CAD patients was 47%. There was 3 times lower number of patients with prefrailty (15%). Patients with prefrailty and frailty significantly more often had hypertension (p=0.001), smoking (p=0.008) and previous stroke (p=0.031). When analyzing the characteristics of intraoperative and early postoperative period after CABG, we found no significant differences in the incidence of complications and adverse outcomes. There were no significant between-group differences in the incidence of endpoints after a year. However, the number of cardiovascular deaths within a year after CABG was significantly higher among frail patients (2 (1.3%) deaths among patients without frailty, 3 (5.2%) deaths among patients with prefrailty and 7 (3.8%) deaths among patients with frailty, p=0.041, OR 1.4, CI 95%, 1.2—2.2).

CONCLUSION

Frailty is a predictor of adverse outcomes in patients with CAD undergoing myocardial revascularization in early and long-term follow-up period.

Keywords:

frailty

prefrailty

coronary artery disease

coronary artery bypass grafting

adverse outcome

Authors:

Krivoshapova K.E.

Research Institute for Complex Issues of Cardiovascular Diseases

ORCID: 0000-0003-2384-5682

Trusov K.E.

Research Institute for Complex Issues of Cardiovascular Diseases

ORCID: 0000-0003-3972-6979

Zhidkova E.I.

Research Institute for Complex Issues of Cardiovascular Diseases

ORCID: 0000-0002-0072-1022

Barbarash O.L.

Research Institute for Complex Issues of Cardiovascular Diseases

SPIN RSCI: 5373-7620
Scopus AuthorID: 56699731800
ResearcherID: A-4834-2017
ORCID: 0000-0002-4642-3610

Received:

07.06.2023

Accepted:

06.08.2023

List of references:

He W, Goodkind D, Kowal P. An Aging World: 2015. Washington DC. https://www.census.gov/content/dam/Census/library/publications/2016/demo/p95-16-1.pdf.AccessedOctober1,2019
Statistics Canada: The Canadian Population in 2011: Age and Sex. 2011. Ottawa ON.
Organization for Economic Co-operation and Development. Elderly population (indicator). https://data.oecd.org/pop/elderly-population.htm.AccessedOctober1,2019
Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract. 2001;4(4):172-177.
Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865-877. https://doi.org/10.1016/j.jamcollsurg.2006.08.026
Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238(2):170-177. https://doi.org/10.1097/01.SLA.0000081085.98792.3d
Fowler AJ, Abbott TEF, Prowle J, Pearse RM. Age of patients undergoing surgery. Br J Surg. 2019;106(8):1012-1018. https://doi.org/10.1002/bjs.11148
McIsaac DI, Wijeysundera DN, Huang A, et al. Association of the hospital volume of frail surgical patients cared for with outcomes after elective, major noncardiac surgery: a Retrospective Population-based Cohort Study. Anesthesiology. 2017;126(4):602-613. https://doi.org/10.1097/ALN.0000000000001536
King A, Bottle A, Faiz O, Aylin P. Investigating adverse event free admissions in medicare inpatients as a patient safety indicator. Ann Surg. 2017;265(5):910-915. https://doi.org/10.1097/SLA.0000000000001792
Harris EP, MacDonald DB, Boland L, et al. Personalized perioperative medicine: a scoping review of personalized assessment and communication of risk before surgery. Can J Anaesth. 2019;66(9):1026-1037. https://doi.org/10.1007/s12630-019-01432-6
Tkacheva ON, Kotovskaya YV, Runikhina NK, et al. Clinical guidelines on frailty. Russian Journal of Geriatric Medicine. 2020;(1):11-46. (In Russ.). https://doi.org/10.37586/2686-8636-1-2020-11-46
Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255-263. https://doi.org/10.1093/gerona/59.3.m255
Robinson TN, Walston JD, Brummel NE, et al. Frailty for surgeons: review of a national institute on aging conference on frailty for specialists. J Am Coll Surg. 2015;221(6):1083-1092. https://doi.org/10.1016/j.jamcollsurg.2015.08.428
Rockwood K, Song X, Mitnitski A. Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey. CMAJ. 2011;183(8):E487-E494. https://doi.org/10.1503/cmaj.101271
Rodríguez-Mañas L, Féart C, Mann G, et al. FOD-CC group (Appendix 1). Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci. 2013;68(1):62-67. https://doi.org/10.1093/gerona/gls119
McIsaac DI, Bryson GL, van Walraven C. Association of frailty and 1-year postoperative mortality following major elective noncardiac surgery: a Population-Based Cohort Study. JAMA Surg. 2016;151(6):538-545. https://doi.org/10.1001/jamasurg.2015.5085
Bagshaw M, Majumdar SR, Rolfson DB, et al. A prospective multicenter cohort study of frailty in younger critically ill patients. Crit Care. 2016;20(1):175. https://doi.org/10.1186/s13054-016-1338-x
Fried LP, Tangen CM, Walston J, et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156. https://doi.org/10.1093/gerona/56.3.m146
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489-495. https://doi.org/10.1503/cmaj.050051
Krivoshapova KE, Vegner EA, Terentyeva NA, et al. Frailty syndrome in patients with coronary artery disease. Medical alphabet. 2020;1(19):6-10. (In Russ.). https://doi.org/10.33667/2078-5631-2020-19-6-10
Krivoshapova KE, Barbarash OL, Vegner EA, et al. The patient with ischemic heart disease and frailty syndrome: characteristics of multimorbidity and in-hospital prognosis after coronary artery bypass surgery. Russian journal of thoracic and cardiovascular surgery. 2022;64(2):161-168. (In Russ.). https://doi.org/10.24022/0236-2791-2022-64-2-161-168
Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734-745. https://doi.org/10.1093/ejcts/ezs043
Shahian DM, O’Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery. Ann Thorac Surg. 2009;88(1 Suppl):S2-22. https://doi.org/10.1016/j.athoracsur.2009.05.053
Wu C, Camacho FT, Wechsler AS, et al. Risk score for predicting long-term mortality after coronary artery bypass graft surgery. Circulation. 2012;125(20):2423-2430. https://doi.org/10.1161/CIRCULATIONAHA.111.055939
Zaidi AM, Fitzpatrick AP, Keenan DJ, et al. Good outcomes from cardiac surgery in the over 70s. Heart. 1999;82(2):134-137. https://doi.org/10.1136/hrt.82.2.134
Fruitman DS, MacDougall CE, Ross DB. Cardiac surgery in octogenarians: can elderly patients benefit?: quality of life after cardiac surgery. Ann Thorac Surg. 1999;68(6):2129-2135. https://doi.org/10.1016/s0003-4975(99)00818-8
Dalrymple-Hay MJ, Alzetani A, Aboel-Nazar S, et al. Cardiac surgery in the elderly. Eur J Cardiothorac Surg. 1999;15(1):61-66. https://doi.org/10.1016/s1010-7940(98)00286-3
Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011;27(1):17-26. https://doi.org/10.1016/j.cger.2010.08.008
Sepehri A, Beggs T, Hassan A, et al. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg. 2014;148(6):3110-3117. https://doi.org/10.1016/j.jtcvs.2014.07.087
Hiraoka A, Saito K, Chikazawa G, et al. Modified predictive score based on frailty for mid-term outcomes in open total aortic arch surgery. Eur J Cardiothorac Surg. 2018;54:42-47. https://doi.org/10.1093/ejcts/ezy001

Close metadata