Cardiac Surgery among the Frail and Elderly Towards Optimal Decision Making
This study will recruit patients over the age of 65 referred for cardiac surgery, and measure frailty through sensitive and validated measures.
Possible Research Results
Impact of findings: This work may demonstrate the impact of lesser degrees of frailty on the ultimate fate of patients in terms of their own estimation quality of life, living situation and decisional regret or satisfaction about a choice for surgery. These outcomes may inform future decision making about cardiac surgery for frail elderly patients. We were the first to demonstrate the relationship between frailty and adverse outcomes in cardiac surgery, but despite replication of this observation by others we still lack a clear understanding of this issue. In addition, a better understanding of frailty will inform our current efforts in developing Shared Decision Making (SDM) programs for patients referred for cardiac surgery and their families. Including a more sensitive measure of frailty in our development of individualized risk model will provide us the opportunity to better inform patients regarding their surgical decision with the use of decision aids and patient navigator support.
About the Project
Previous research has demonstrated that frailty among cardiac surgery patients confers increased risk of mortality, major morbidity, and prolonged institutional care and described, in a Canadian context, a marked increase in frail and elderly patients referred for cardiac surgery interventions over the last decade. However, the impact of frailty on the ultimate functional recovery, independence and quality of life among elderly patients undergoing cardiac surgery is not known.
In preliminary work we utilized the FACT, a more sensitive tool based on the Clinical Frailty Scale but with greater detail in terms of the domains in which the frailty resides. We propose to more fully explore the relationship between more subtle degrees of frailty and cardiac surgical outcomes.
Secondly, while we have demonstrated that frailty confers an increased risk of prolonged institutional care, we were not able to follow patients effectively past discharge. It is critical to understand the fate of frail patients at 6 months post-operatively, when there has been a sufficient chance for recovery from the surgical insult. The impact of surgery on the patient’s quality of life needs to be more fully explored, and this includes living situation and functional independence.
For more details on the project rationale, objectives and research plan, click here.
Greg Hirsch, MD -- Nova Scotia Health Authority
Janet Curran, PhD -- Dalhousie University
Ansar Hassan, MD, PhD -- Saint John Regional Hospital
Knowledge Users and Partners:
David Kirkpatrick, MD, FRCS(C) -- Halifax Infirmary
Project Contact: Greg Hirsch -- firstname.lastname@example.org