THE HIGH-PRIORITY ISSUE OF FRAILTY IN CARDIAC SURGERY
Daniel Hernandez-Vaquero Panizo, Hospital Universitario Central de Asturias (HUCA)
24 March 2015
We read with great interest the article by Scandroglio AM [1] analyzing the outcomes of a cohort of octogenarian patients undergoing cardiac surgery in a single center. [1]
However and despite studing octogenarian patients, where frailty is prevalent, no measures of frailty or “biological age” (rather than “chronological age”) were considered.
Frailty has become a high-priority theme in cardiovascular medicine. Frailty from the French frêle, meaning of little resistance, is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Cardiac surgery is one of the biggest acute iatrogenic stressors to which the patient’s resiliency will determine their postoperative course. [2]
Frailty has shown in some studies to be one of the most important predictors for mortality after cardiac surgery. Slow 5-m gait speed was associated with a 3-fold increase in post-operative mortality or major morbidity [3]. Gait speed, as the best measure of frailty, was able to improve the discrimination power of the Society for Thoracic Surgeons risk score (area under the curve 0.70 for risk score alone vs. area under the curve 0.74 for risk score plus gait speed). Patients with slow gait speed and a high risk score had a 43% incidence of mortality/morbidity, whereas those with normal gait speed and a low to intermediate risk score had only a 6% incidence.
It is evident that frail patients who undergo cardiac surgery have higher rates of post-operative mortality, morbidity, prolonged length of stay, and need for discharge to facilities. From our point of view, “biological age” rather than “chronological age” is one of the most important predictors for mortality after cardiac surgery but it still needs to be further investigated. Therefore, we think that this study [1] is a failed opportunity to shed light of outcomes in frail patients undergoing cardiac surgery.
3. Afilalo J, Eisenberg MJ, Morin J-F, Bergman H, Monette J, Noiseux N et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients under- going cardiac surgery. J Am Coll Cardiol. 2010;56:1668–76.
THE HIGH-PRIORITY ISSUE OF FRAILTY IN CARDIAC SURGERY
24 March 2015
We read with great interest the article by Scandroglio AM [1] analyzing the outcomes of a cohort of octogenarian patients undergoing cardiac surgery in a single center. [1]
However and despite studing octogenarian patients, where frailty is prevalent, no measures of frailty or “biological age” (rather than “chronological age”) were considered.
Frailty has become a high-priority theme in cardiovascular medicine. Frailty from the French frêle, meaning of little resistance, is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Cardiac surgery is one of the biggest acute iatrogenic stressors to which the patient’s resiliency will determine their postoperative course. [2]
Frailty has shown in some studies to be one of the most important predictors for mortality after cardiac surgery. Slow 5-m gait speed was associated with a 3-fold increase in post-operative mortality or major morbidity [3]. Gait speed, as the best measure of frailty, was able to improve the discrimination power of the Society for Thoracic Surgeons risk score (area under the curve 0.70 for risk score alone vs. area under the curve 0.74 for risk score plus gait speed). Patients with slow gait speed and a high risk score had a 43% incidence of mortality/morbidity, whereas those with normal gait speed and a low to intermediate risk score had only a 6% incidence.
It is evident that frail patients who undergo cardiac surgery have higher rates of post-operative mortality, morbidity, prolonged length of stay, and need for discharge to facilities. From our point of view, “biological age” rather than “chronological age” is one of the most important predictors for mortality after cardiac surgery but it still needs to be further investigated. Therefore, we think that this study [1] is a failed opportunity to shed light of outcomes in frail patients undergoing cardiac surgery.
REFERENCES
1. Scandroglio AM, Finco G, Pieri M, Ascari R, Calabrò MG, Taddeo D et al. Cardiac surgery in 260 octogenarians: a case series BMC Anesthesiol. 2015;15:15
2. Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014;63:747-62
3. Afilalo J, Eisenberg MJ, Morin J-F, Bergman H, Monette J, Noiseux N et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients under- going cardiac surgery. J Am Coll Cardiol. 2010;56:1668–76.
Competing interests
NONE