Frailty Predicts Outcomes for Elderly After Heart Surgery

By Andrew M. Seaman

(Reuters Health) - Measuring the frailty of older adults before heart surgery helps to predict how well they'll survive and thrive, suggests a new analysis.

Using mobility, disability and nutrition to measure their frailty before major heart surgery may predict whether they'll be alive six or more months later, researchers reported online August 22 in the Annals of Internal Medicine.

Similarly, those traits may also predict whether people will survive, and how active they'll be, after minor heart procedures.

"The current preoperative assessments that physicians are using are not including any markers of frailty," said lead author Dr. Dae Hyun Kim, of Beth Israel Deaconess Medical Center in Boston. "There have been some studies considering markers of frailty can help us predict outcomes after surgery."

Knowing how likely people are to survive six or more months after heart operations or how functional they'll be could help doctors and patients determine whether the surgery is worthwhile, Kim told Reuters Health.

Also, he said, "this frailty assessment can allow the clinical team to individualize the perioperative care for the individual's need."

"The frailty assessment can inform that decision making process about what patients really want and what the surgery can actually bring to the patient," Kim said.

To evaluate the instruments used to measure frailty, the researchers analyzed earlier studies done in people age 60 or older. Eight of the studies tested a total of nine frailty instruments in 18,388 patients undergoing major heart operations. Seventeen studies tested 13 frailty instruments in 5,177 patients undergoing minimally invasive heart procedures.

Overall, instruments that measured mobility, disability or nutrition status were best for predicting outcomes after heart surgeries.

For example, in one study, people undergoing major heart operations were asked to perform a simple mobility task. Among those who completed the task the fastest, 2% died within the next year, compared to 12% of those who were slowest at the task.

No studies looked at whether frailty scores can predict functional outcomes after major surgeries. But for a minor heart operation, measuring frailty helped predict both the likelihood of death and the ability to perform daily tasks months later.

One study tested a multi-component frailty tool that measures walking speed, grip strength, blood work and disability. Half of those with higher frailty scores died or had a lower quality of life, compared to about a third of those who had lower frailty scores.

Kim said single-component instruments that only consider one measure like mobility are easier to use and already tested on large groups of people. Multi-component instruments are more comprehensive, but are more difficult to implement and are usually only tested in one medical center.

"I think the bigger message is that measuring frailty with any measure is better than not measuring frailty," he said.

Drs. Victoria Tang and Kenneth Covinsky, of the University of California, San Francisco, agree in an editorial that the new analysis supports frailty assessments in older adults who are thinking about having surgery.

"Once the decision to have surgery is made, we may better prepare patients and their family members for the possible outcomes and provide needed support, possibly including palliative care," they write.

SOURCE: https://bit.ly/2bJyoLe

Ann Intern Med 2016.

(c) Copyright Thomson Reuters 2016. Click For Restrictions - https://about.reuters.com/fulllegal.asp