Cardiac Surgery among the Frail and Elderly Towards Optimal Decision Making

This study recruited patients over the age of 65 referred for cardiac surgery, and measured frailty through sensitive and validated measures.

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 proposed 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.

See below for more details on the project rationale, objectives and research plan.

Project Team

Principal Investigator:

Greg Hirsch, MD — Nova Scotia Health Authority

Co-Investigators:

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 — greg.hirsch@cdha.nshealth.ca

FRA 2015-B-22

Rationale

This study will recruit patients over the age of 65 referred for cardiac surgery, and measure frailty through sensitive and validated measures.

Principal Investigator

Greg Hirsch, MD — Nova Scotia Health Authority

Rationale: Two major gaps remain in our knowledge about frailty and cardiac surgery. Firstly, our measure by Katz Index, and those of other groups, are relatively insensitive. Even one measure of frailty in our study had a major negative impact on outcome, raising a question about lesser degrees of frailty. In our pilot project, fully 52% of patient over the age of 65 were frail, and among these patients, rates of mortality, major morbidity, and prolonged institutional care were increased. 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 six months post-operatively, when there has been a sufficient chance for recovery from the surgical insult.

Objectives: The purpose of the current proposal is to improve our understanding of the contribution of frailty and age on the ultimate functional recovery of patients undergoing cardiac surgery at the QE II Health Sciences Centre in Halifax and the New Brunswick Heart Centre in Saint John. Specifically, we will determine the impact of varying degrees of frailty on the functional recovery of patients referred for cardiac surgery. Frailty will be assessed preoperatively using the Clinical Frailty Scale and the FACT tool, a frailty instrument pioneered at our institution that categorizes frailty in domains of mobility, social, daily tasks and memory. Health related quality of life will be measured preoperatively and at six months using EQ-5D-3L and EQ-VAS.

Research Plan: We will recruit patients over the age of 65 referred for cardiac surgery, and measure frailty through sensitive and validated measures. Health related quality of life will be measured preoperatively. Post-operative clinical outcomes will be determined. Health related quality of life, independence in living situation, satisfaction with decision making around surgery will all be sought at six months.

Back to FRA 2015-B-22 Project Page