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Frailty may predict long-term mortality risk in CABG
Frailty was independently associated with long-term mortality in patients who underwent CABG, according to a study published in the Journal of the American Heart Association.
“Frailty should be incorporated into preoperative risk stratification models to assist with optimal selection of operative candidates,” Louise Y. Sun, MD, SM, clinician investigator and staff anesthesiologist in the division of cardiac anesthesiology at University of Ottawa Heart Institute and adjunct scientist at Institute for Clinical Evaluative Sciences in Ottawa, Canada, said in a press release. “Effective preoperative optimization programs such as cardiac prehabilitation, nutritional augmentation and psychosocial support may improve outcomes, especially in younger patients.”
Diem T.T. Tran, MD, MSc, FRCPC, assistant professor of anesthesiology in the department of anesthesiology and pain medicine at University of Ottawa Heart Institute, and colleagues analyzed data from 40,083 patients aged at least 40 years who underwent primary isolated CABG between October 2008 and March 2015. Those who had a history of cardiac surgery were excluded.
Data were collected from health care databases with information related to demographics, comorbidity and procedures. Frailty was assessed with the Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator, which took into account dementia, malnutrition, decubitus ulcer, impaired vision, weight loss, incontinence of urine, barriers to access to care, poverty, falls and difficulty in walking.
Other information that was reviewed included comorbidities, socioeconomic status, procedural status, height, weight, BMI and preoperative ejection fraction.
The primary outcome was all-cause death.
Of the patients in this study, 22% were frail. During a mean follow-up of 4 years, the age- and sex-standardized mortality rate per 1,000 person-years was higher in patients who were frail (33; 95% CI, 29-36) compared with those who were not frail (22; 95% CI, 19-24).
Patients who were frail had an increased risk for long-term mortality compared with those who were not frail (adjusted HR = 1.2; 95% CI, 1.12-1.28). Differences among both groups were greater in patients aged 40 to 74 years and smaller in those who were aged at least 85 years.
“The high burden of frailty in patients undergoing CABG accentuates the need for further research to validate these more inclusive risk scores in larger population-based cohorts and for prospective trials guided by these new scores to determine whether alternative revascularization strategies (eg, percutaneous coronary intervention) and/or comprehensive preoperative nutritional, psychological support and physical conditioning programs would improve outcomes in frail patients,” Tran and colleagues wrote. – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.