Advances in the relationship between frailty and cardiac surgery in elderly patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIANG Yuping ¹ , ZENG Ling ¹ , LUO Tianhui ¹ ,  QIAN Yongjun ²

1. Department of Thoracic Surgery ICU, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

QIAN Yongjun, Email: qianyongjun@scu.edu.cn

Keywords：

Frailty; elderly; cardiac surgery; assessment

DOI：

10.7507/1007-4848.201902004

Video：

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Frailty is a syndrome characterized by vulnerability to stressors due to loss of physiological reserve. In recent years, many researches have confirmed that frailty is a risk factor for postoperative complications of cardiac surgery, such as readmission, adverse cardiovascular events, and death in elderly patients. This paper reviews the concept of frailty, the relationship between frailty and cardiac surgery, the frailty assessment and intervention strategy in perioperative period, aimed at providing decision making basis for the risk stratification and perioperative management of cardiac surgery in elderly patients.

Citation： XIANG Yuping, ZENG Ling, LUO Tianhui, QIAN Yongjun. Advances in the relationship between frailty and cardiac surgery in elderly patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 218-222. doi: 10.7507/1007-4848.201902004 Copy

1.	Afilalo J, Kim S, O'Brien S, et al. Gait speed and operative mortality in older adults following cardiac surgery. JAMA Cardiol, 2016, 1(3): 314-321.
2.	Ngaage DL, Britchford G, Cale ARJ. The influence of an ageing population on care and clinical resource utilisation in cardiac surgery. Br J Cardiol, 2011, 18(1): 28-32.
3.	Huded CP, Huded JM, Friedman JL, et al. Frailty status and outcomes after transcatheter aortic valve implantation. Am J Cardiol, 2016, 117(12): 1966-1971.
4.	Lytwyn J, Stammers AN, Kehler DS, et al. The impact of frailty on functional survival in patients 1 year after cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(6): 1990-1999.
5.	Koh LY, Hwang NC. Frailty in cardiac surgery. J Cardiothorac Vasc Anesth, 2019, 33(2): 521-531.
6.	Barili F, Pacini D, Capo A, et al. Does EuroSCORE Ⅱ perform better than its original versions? A multicentre validation study. Eur Heart J, 2013, 34(1): 22-29.
7.	Puls M, Sobisiak B, Bleckmann A, et al. Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living. EuroIntervention, 2014, 10(5): 609-619.
8.	葛翼鹏, 许建屏, 孙立忠. 欧洲心脏手术风险评估系统预测中国人心瓣膜手术后并发症的发生及预后. 中国胸心血管外科临床杂志, 2010, 17(5): 357-360.
9.	Puskas JD, Kilgo PD, Thourani VH, et al. The society of thoracic surgeons 30-day predicted risk of mortality score also predicts long-term survival. Ann Thorac Surg, 2012, 93(1): 26-33.
10.	Steinvil A, Buchanan KD, Kiramijyan S, et al. Utility of an additive frailty tests index score for mortality risk assessment following transcatheter aortic valve replacement. Am Heart J, 2018, 200: 11-16.
11.	Schoenenberger AW, Moser A, Bertschi D, et al. Improvement of risk prediction after transcatheter aortic valve replacement by combining frailty with conventional risk scores. JACC Cardiovasc Interv, 2018, 11(4): 395-403.
12.	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
13.	Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ, 2005, 173(5): 489-495.
14.	Gobbens RJ, van Assen MA, Luijkx KG, et al. Testing an integral conceptual model of frailty. J Adv Nurs, 2012, 68(9): 2047-2060.
15.	Li H, Manwani B, Leng SX. Frailty, inflammation, and immunity. Aging Dis, 2011, 2(6): 466-473.
16.	Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev, 2016, 31(8): 1-8.
17.	Lebherz C, Kahles F, Piotrowski K, et al. Interleukin-6 predicts inflammation-induced increase of Glucagon-like peptide-1 in humans in response to cardiac surgery with association to parameters of glucose metabolism. Cardiovasc Diabetol, 2016, 15: 21.
18.	Chen LY, Wu YH, Liu LK, et al. Association among serum insulin-like growth factor-1, frailty, muscle mass, bone mineral density, and physical performance among community-dwelling middle-aged and older adults in Taiwan. Rejuvenation Res, 2018, 21(3): 270-277.
19.	Mikkelsen MM, Hansen TK, Gjedsted J, et al. Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study. J Cardiothorac Surg, 2010, 5: 129.
20.	Jung P, Pereira MA, Hiebert B, et al. The impact of frailty on postoperative delirium in cardiac surgery patients. J Thorac Cardiovasc Surg, 2015, 149(3): 869-875.
21.	Brown CH 4th, Max L, LaFlam A, et al. The association between preoperative frailty and postoperative delirium after cardiac surgery. Anesth Analg, 2016, 123(2): 430-435.
22.	Afilalo J, Mottillo S, Eisenberg MJ, et al. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes, 2012, 5(2): 222-228.
23.	Lee DH, Buth KJ, Martin BJ, et al. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation, 2010, 121(8): 973-978.
24.	Reichart D, Rosato S, Nammas W, et al. Clinical frailty scale and outcome after coronary artery bypass grafting. Eur J Cardiothorac Surg, 2018, 54(6): 1102-1109.
25.	Kim DH, Kim CA, Placide S, et al. Preoperative frailty assessment and outcomes at 6 months or later in older adults undergoing cardiac surgical procedures: a systematic review. Ann Intern Med, 2016, 165(9): 650-660.
26.	Thongprayoon C, Cheungpasitporn W, Thamcharoen N, et al. Association of frailty status with acute kidney injury and mortality after transcatheter aortic valve replacement: A systematic review and meta-analysis. PLoS One, 2017, 12(5): e0177157.
27.	Morton S, Isted A, Avery P, et al. Is frailty a predictor of outcomes in elderly inpatients with acute kidney injury? A prospective cohort study. Am J Med, 2018, 131(10): 1251-1256.
28.	Anand A, Harley C, Visvanathan A, et al. The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes, 2017, 3(2): 123-132.
29.	Shimura T, Yamamoto M, Kano S, et al. Impact of the clinical frailty scale on outcomes after transcatheter aortic valve replacement. Circulation, 2017, 135(21): 2013-2024.
30.	Okoh AK, Chauhan D, Kang N, et al. The impact of frailty status on clinical and functional outcomes after transcatheter aortic valve replacement in nonagenarians with severe aortic stenosis. Catheter Cardiovasc Interv, 2017, 90(6): 1000-1006.
31.	Kobe AR, Meyer A, Elmubarak H, et al. Frailty assessed by the FORECAST is a valid tool to predict short-term outcome after transcatheter aortic valve replacement. Innovations (Phila), 2016, 11(6): 407-413.
32.	Saji M, Higuchi R, Tobaru T, et al. Impact of frailty markers for unplanned hospital readmission following transcatheter aortic valve implantation. Circ J, 2018, 82(8): 2191-2198.
33.	Eichler S, Salzwedel A, Harnath A, et al. Frailty as a predictor for all-cause mortality in patients 12 months after transcatheter aortic valve implantation (TAVI). Màlaga: Europrevent 2017, 2017.
34.	Metze C, Matzik AS, Scherner M, et al. Impact of frailty on outcomes in patients undergoing percutaneous mitral valve repair. JACC Cardiovasc Interv, 2017, 10(19): 1920-1929.
35.	Goldfarb M, Bendayan M, Rudski LG, et al. Cost of cardiac surgery in frail compared with nonfrail older adults. Can J Cardiol, 2017, 33(8): 1020-1026.
36.	Green P, Woglom AE, Genereux P, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv, 2012, 5(9): 974-981.
37.	Rogers T, Alraies MC, Moussa Pacha H, et al. Clinical frailty as an outcome predictor after transcatheter aortic valve implantation. Am J Cardiol, 2018, 121(7): 850-855.
38.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease : A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
39.	Sündermann S, Dademasch A, Praetorius J, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg, 2011, 39(1): 33-37.
40.	Afilalo J, Lauck S, Kim DH, et al. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol, 2017, 70(6): 689-700.
41.	Rodrigues MK, Marques A, Lobo DML, et al. Pre-frailty increases the risk of adverse events in older patients undergoing cardiovascular surgery. Arq Bras Cardiol, 2017, 109(4): 299-306.
42.	Amabili P, Wozolek A, Noirot I, et al. The edmonton frail scale improves the prediction of 30-day mortality in elderly patients undergoing cardiac surgery: a prospective observational study. J Cardiothorac Vasc Anesth, 2019, 33(4): 945-952.
43.	Theou O, Stathokostas L, Roland KP, et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res, 2011, 2011: 569194.
44.	Vigorito C, Abreu A, Ambrosetti M, et al. Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section. Eur J Prev Cardiol, 2017, 24(6): 577-590.
45.	Waite I, Deshpande R, Baghai M, et al. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg, 2017, 12(1): 91.
46.	Stammers AN, Kehler DS, Afilalo J, et al. Protocol for the PREHAB study-Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial. BMJ Open, 2015, 5(3): e007250.

1. Afilalo J, Kim S, O'Brien S, et al. Gait speed and operative mortality in older adults following cardiac surgery. JAMA Cardiol, 2016, 1(3): 314-321.
2. Ngaage DL, Britchford G, Cale ARJ. The influence of an ageing population on care and clinical resource utilisation in cardiac surgery. Br J Cardiol, 2011, 18(1): 28-32.
3. Huded CP, Huded JM, Friedman JL, et al. Frailty status and outcomes after transcatheter aortic valve implantation. Am J Cardiol, 2016, 117(12): 1966-1971.
4. Lytwyn J, Stammers AN, Kehler DS, et al. The impact of frailty on functional survival in patients 1 year after cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(6): 1990-1999.
5. Koh LY, Hwang NC. Frailty in cardiac surgery. J Cardiothorac Vasc Anesth, 2019, 33(2): 521-531.
6. Barili F, Pacini D, Capo A, et al. Does EuroSCORE Ⅱ perform better than its original versions? A multicentre validation study. Eur Heart J, 2013, 34(1): 22-29.
7. Puls M, Sobisiak B, Bleckmann A, et al. Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living. EuroIntervention, 2014, 10(5): 609-619.
8. 葛翼鹏, 许建屏, 孙立忠. 欧洲心脏手术风险评估系统预测中国人心瓣膜手术后并发症的发生及预后. 中国胸心血管外科临床杂志, 2010, 17(5): 357-360.
9. Puskas JD, Kilgo PD, Thourani VH, et al. The society of thoracic surgeons 30-day predicted risk of mortality score also predicts long-term survival. Ann Thorac Surg, 2012, 93(1): 26-33.
10. Steinvil A, Buchanan KD, Kiramijyan S, et al. Utility of an additive frailty tests index score for mortality risk assessment following transcatheter aortic valve replacement. Am Heart J, 2018, 200: 11-16.
11. Schoenenberger AW, Moser A, Bertschi D, et al. Improvement of risk prediction after transcatheter aortic valve replacement by combining frailty with conventional risk scores. JACC Cardiovasc Interv, 2018, 11(4): 395-403.
12. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
13. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ, 2005, 173(5): 489-495.
14. Gobbens RJ, van Assen MA, Luijkx KG, et al. Testing an integral conceptual model of frailty. J Adv Nurs, 2012, 68(9): 2047-2060.
15. Li H, Manwani B, Leng SX. Frailty, inflammation, and immunity. Aging Dis, 2011, 2(6): 466-473.
16. Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev, 2016, 31(8): 1-8.
17. Lebherz C, Kahles F, Piotrowski K, et al. Interleukin-6 predicts inflammation-induced increase of Glucagon-like peptide-1 in humans in response to cardiac surgery with association to parameters of glucose metabolism. Cardiovasc Diabetol, 2016, 15: 21.
18. Chen LY, Wu YH, Liu LK, et al. Association among serum insulin-like growth factor-1, frailty, muscle mass, bone mineral density, and physical performance among community-dwelling middle-aged and older adults in Taiwan. Rejuvenation Res, 2018, 21(3): 270-277.
19. Mikkelsen MM, Hansen TK, Gjedsted J, et al. Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study. J Cardiothorac Surg, 2010, 5: 129.
20. Jung P, Pereira MA, Hiebert B, et al. The impact of frailty on postoperative delirium in cardiac surgery patients. J Thorac Cardiovasc Surg, 2015, 149(3): 869-875.
21. Brown CH 4th, Max L, LaFlam A, et al. The association between preoperative frailty and postoperative delirium after cardiac surgery. Anesth Analg, 2016, 123(2): 430-435.
22. Afilalo J, Mottillo S, Eisenberg MJ, et al. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes, 2012, 5(2): 222-228.
23. Lee DH, Buth KJ, Martin BJ, et al. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation, 2010, 121(8): 973-978.
24. Reichart D, Rosato S, Nammas W, et al. Clinical frailty scale and outcome after coronary artery bypass grafting. Eur J Cardiothorac Surg, 2018, 54(6): 1102-1109.
25. Kim DH, Kim CA, Placide S, et al. Preoperative frailty assessment and outcomes at 6 months or later in older adults undergoing cardiac surgical procedures: a systematic review. Ann Intern Med, 2016, 165(9): 650-660.
26. Thongprayoon C, Cheungpasitporn W, Thamcharoen N, et al. Association of frailty status with acute kidney injury and mortality after transcatheter aortic valve replacement: A systematic review and meta-analysis. PLoS One, 2017, 12(5): e0177157.
27. Morton S, Isted A, Avery P, et al. Is frailty a predictor of outcomes in elderly inpatients with acute kidney injury? A prospective cohort study. Am J Med, 2018, 131(10): 1251-1256.
28. Anand A, Harley C, Visvanathan A, et al. The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes, 2017, 3(2): 123-132.
29. Shimura T, Yamamoto M, Kano S, et al. Impact of the clinical frailty scale on outcomes after transcatheter aortic valve replacement. Circulation, 2017, 135(21): 2013-2024.
30. Okoh AK, Chauhan D, Kang N, et al. The impact of frailty status on clinical and functional outcomes after transcatheter aortic valve replacement in nonagenarians with severe aortic stenosis. Catheter Cardiovasc Interv, 2017, 90(6): 1000-1006.
31. Kobe AR, Meyer A, Elmubarak H, et al. Frailty assessed by the FORECAST is a valid tool to predict short-term outcome after transcatheter aortic valve replacement. Innovations (Phila), 2016, 11(6): 407-413.
32. Saji M, Higuchi R, Tobaru T, et al. Impact of frailty markers for unplanned hospital readmission following transcatheter aortic valve implantation. Circ J, 2018, 82(8): 2191-2198.
33. Eichler S, Salzwedel A, Harnath A, et al. Frailty as a predictor for all-cause mortality in patients 12 months after transcatheter aortic valve implantation (TAVI). Màlaga: Europrevent 2017, 2017.
34. Metze C, Matzik AS, Scherner M, et al. Impact of frailty on outcomes in patients undergoing percutaneous mitral valve repair. JACC Cardiovasc Interv, 2017, 10(19): 1920-1929.
35. Goldfarb M, Bendayan M, Rudski LG, et al. Cost of cardiac surgery in frail compared with nonfrail older adults. Can J Cardiol, 2017, 33(8): 1020-1026.
36. Green P, Woglom AE, Genereux P, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv, 2012, 5(9): 974-981.
37. Rogers T, Alraies MC, Moussa Pacha H, et al. Clinical frailty as an outcome predictor after transcatheter aortic valve implantation. Am J Cardiol, 2018, 121(7): 850-855.
38. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease : A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
39. Sündermann S, Dademasch A, Praetorius J, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg, 2011, 39(1): 33-37.
40. Afilalo J, Lauck S, Kim DH, et al. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol, 2017, 70(6): 689-700.
41. Rodrigues MK, Marques A, Lobo DML, et al. Pre-frailty increases the risk of adverse events in older patients undergoing cardiovascular surgery. Arq Bras Cardiol, 2017, 109(4): 299-306.
42. Amabili P, Wozolek A, Noirot I, et al. The edmonton frail scale improves the prediction of 30-day mortality in elderly patients undergoing cardiac surgery: a prospective observational study. J Cardiothorac Vasc Anesth, 2019, 33(4): 945-952.
43. Theou O, Stathokostas L, Roland KP, et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res, 2011, 2011: 569194.
44. Vigorito C, Abreu A, Ambrosetti M, et al. Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section. Eur J Prev Cardiol, 2017, 24(6): 577-590.
45. Waite I, Deshpande R, Baghai M, et al. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg, 2017, 12(1): 91.
46. Stammers AN, Kehler DS, Afilalo J, et al. Protocol for the PREHAB study-Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial. BMJ Open, 2015, 5(3): e007250.

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