While frailty is generally viewed as a consideration for the elderly, new research in the Journal of the American Heart Association suggests it is deadlier in younger patients after coronary artery bypass grafting (CABG).
Authors of the study, led by Louise Sun, MD, of the University of Ottowa Heart Institute in Canada, noted frailty in cardiac patients increased the risk of mortality, major cardiac and cerebrovascular events, and the length of stay in hospitals.
“Frailty is an emerging concept in perioperative medicine but remains a poorly recognized and poorly investigated syndrome in patients undergoing cardiac surgery,” Sun and colleagues wrote. “It is increasing in prevalence and presents a formidable challenge for clinicians who work to optimize these patients.”
The researchers sought to investigate the prevalence of frailty and its association with long-term mortality in patients who underwent CABG over a seven-year period.
Frailty was determined using the Johns Hopkins Adjusted Clinical Groups (ACG) diagnoses indicator, which uses 10 different frailty-related diagnoses—malnutrition, dementia, impaired vision, decubitus ulcer, incontinence of urine, loss of weight, poverty, barriers to access to care, difficulty in walking and falls.
More than 40,000 patients who underwent CABG between 2008 and 2015 were used as the final study cohort. Older age groups had higher rates of frailty, and 22 percent of patients were considered frail.
At 30 days post-CABG, the researchers found almost 2 percent of patients died, of whom 28 percent were frail. Except for the 85 and older group, frail patients had higher rates of 30-day mortality than individuals who were not frail.
During an average follow up time of four years, 11 percent of patients died during long-term follow up—and of those patients, 32 percent were considered frail. Age- and sex-standardized long-term mortality rate per 1,000 person-years was 33 in frail patients and 22 in non-frail patients.
Sun and colleagues found greater differences in the long-term mortality rates between frail and non-frail patients in the younger age group. Frailty contributed to greater differences in the survival of CABG patients between 40 and 74 years of age.
The researchers believe age is not the only factor that can predict outcomes—overall physiological health is more indicative. They believe more research is needed on frailty to determine which patients are better candidates for cardiac procedures and to improve patient outcomes.
“Our findings highlight the need for more comprehensive preoperative risk stratification models to assist with optimal selection of operative candidates,” Sun et al. wrote. “In addition, the subgroup of younger patients who are frail may benefit most from preoperative optimization programs, such as cardiac prehabilitation, nutritional augmentation and psychosocial support.”
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.