Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans

被引:9
|
作者
Kochar, Ajar [1 ,2 ]
Deo, Salil V. [3 ,4 ]
Charest, Brian [5 ]
Peterman-Rocha, Fanny [6 ]
Elgudin, Yakov [3 ,4 ]
Chu, Danny [7 ]
Yeh, Robert W. [2 ]
Rao, Sunil V. [8 ]
Kim, Dae H. [9 ]
Driver, Jane A. [5 ,10 ]
Hall, Daniel E. [11 ,12 ]
Orkaby, Ariela R. [5 ,10 ,13 ]
机构
[1] Harvard Med Sch, Brigham & Womens Hosp, Dept Cardiovasc Med, Boston, MA USA
[2] Harvard Med Sch, Richard & Susan Smith Ctr Outcomes Res Cardiol, Beth Israel Deaconess Med Ctr, Boston, MA USA
[3] Louis Stokes Cleveland VA Med Ctr, Surg Serv, Cleveland, OH USA
[4] Case Western Reserve Univ, Case Sch Med, Cleveland, OH USA
[5] VA Boston Healthcare Syst, Massachusetts Vet Epidemiol Res & Informat Ctr MA, Boston, MA USA
[6] Univ Diego Portales, Fac Med, Santiago, Chile
[7] Univ Pittsburgh, Div Cardiac Surg, Pittsburgh, PA USA
[8] NYU Langone Hlth, Div Intervent Cardiol, New York, NY USA
[9] Harvard Med Sch, Hinda & Arthur Marcus Inst Aging Res, Hebrew SeniorLife, Boston, MA USA
[10] VA Boston Healthcare Syst, New England Geriatr Res Educ & Clin Ctr GRECC, Boston, MA USA
[11] Univ Pittsburgh, Wolff Ctr, Med Ctr, Pittsburgh, OH USA
[12] Vet Affairs Pittsburgh Healthcare Syst, Ctr Hlth Equ Res & Promot, Pittsburgh, OH USA
[13] Harvard Med Sch, Brigham & Womens Hosp, Div Aging, Boston, MA USA
关键词
coronary artery bypass grafting; coronary artery disease; frailty; HEALTH; INTERVENTION; DEPRESSION; MORTALITY; DISEASE;
D O I
10.1111/jgs.18390
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background: Contemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients. Methods: We conducted a retrospective cohort study (2016-2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafting (CABG). Frailty was quantified by the Veterans Administration Frailty Index (VA-FI), which applies the cumulative deficit method to render a proportion of 30 pertinent diagnosis codes. Patients were classified as non-frail (VA-FI <= 0.1), pre-frail (0.1 < VA-FI <= 0.2), or frail (VA-FI > 0.2). We used Cox proportional hazards models to ascertain the association of frailty with all-cause mortality. Our primary study outcome was 5-year all-cause mortality; the co-primary outcome was days alive and out of the hospitalwithin the first postoperative year. Results: There were 13,554 CABG patients (median 69 years, 79% White, 1.5% women). The mean pre-operative VA-FI was 0.21 (SD: 0.11); 31% were pre-frail (VA-FI: 0.17) and 47% were frail (VA-FI: 0.31). Frail patients were older and had higher co-morbidity burdens than pre-frail and non-frail patients. Compared with non-frail patients (13.0% [11.4, 14.7]), there was a significant association between frail and pre-frail patients and increased cumulative 5-year all-cause mortality (frail: 24.8% [23.3, 26.1]; HR: 1.75 [95% CI 1.54, 2.00]; pre-frail 16.8% [95% CI 15.3, 18.4]; HR 1.2 [1.08,1.34]). Compared with non-frail patients (mean 362[SD 12]), pre-frail (mean 361 [SD 14]; p < 0.01) and frail patients (mean 358[SD 18]; p < 0.01) spent fewer days alive and out of the hospital in the first postoperative year. Conclusions: Pre-frailty and frailty were prevalent among US veterans undergoing CABG and associated with worse mid-term outcomes. Given the high prevalence of frailty with attendant adverse outcomes, there may be an opportunity to improve outcomes by identifying and mitigating frailty before surgery.
引用
收藏
页码:2736 / 2747
页数:12
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