The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery
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 R...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.020219 |
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| author | Joshua Solomon Emmanuel Moss Jean‐Francois Morin Yves Langlois Renzo Cecere Benoit de Varennes Kevin Lachapelle Nicolo Piazza Giuseppe Martucci Melissa Bendayan Palina Piankova Victoria Hayman Marie‐Claude Ouimet Lawrence G. Rudski Jonathan Afilalo |
| author_facet | Joshua Solomon Emmanuel Moss Jean‐Francois Morin Yves Langlois Renzo Cecere Benoit de Varennes Kevin Lachapelle Nicolo Piazza Giuseppe Martucci Melissa Bendayan Palina Piankova Victoria Hayman Marie‐Claude Ouimet Lawrence G. Rudski Jonathan Afilalo |
| author_sort | Joshua Solomon |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T17:34:05Z |
| format | Article |
| id | doaj.art-4ac78f4cc36f472db8b9d4cbd8fafa0e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:34:05Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4ac78f4cc36f472db8b9d4cbd8fafa0e2022-12-22T02:37:27ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-08-01101510.1161/JAHA.120.020219The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass SurgeryJoshua Solomon0Emmanuel Moss1Jean‐Francois Morin2Yves Langlois3Renzo Cecere4Benoit de Varennes5Kevin Lachapelle6Nicolo Piazza7Giuseppe Martucci8Melissa Bendayan9Palina Piankova10Victoria Hayman11Marie‐Claude Ouimet12Lawrence G. Rudski13Jonathan Afilalo14Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC CanadaDivision of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC CanadaDivision of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC CanadaDivision of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC CanadaDivision of Cardiac Surgery McGill University Health Centre Montreal QC CanadaDivision of Cardiac Surgery McGill University Health Centre Montreal QC CanadaDivision of Cardiac Surgery McGill University Health Centre Montreal QC CanadaDivision of Cardiology McGill University Health Centre Montreal QC CanadaDivision of Cardiology McGill University Health Centre Montreal QC CanadaCentre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC CanadaCentre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC CanadaCentre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC CanadaResearch InstituteMcGill University Health Centre Montreal QC CanadaDivision of Cardiology Jewish General HospitalMcGill University Montreal QC CanadaCentre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC CanadaBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.120.020219coronary artery bypass surgeryfrailtymortality |
| spellingShingle | Joshua Solomon Emmanuel Moss Jean‐Francois Morin Yves Langlois Renzo Cecere Benoit de Varennes Kevin Lachapelle Nicolo Piazza Giuseppe Martucci Melissa Bendayan Palina Piankova Victoria Hayman Marie‐Claude Ouimet Lawrence G. Rudski Jonathan Afilalo The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary artery bypass surgery frailty mortality |
| title | The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery |
| title_full | The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery |
| title_fullStr | The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery |
| title_full_unstemmed | The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery |
| title_short | The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery |
| title_sort | essential frailty toolset in older adults undergoing coronary artery bypass surgery |
| topic | coronary artery bypass surgery frailty mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.020219 |
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