Cardiac Surgery among Older Adults Living with Frailty Towards Optimal Decision Making

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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.

Dr. Greg Hirsch, MD is a Professor of Surgery and Director of Research in the Department of Surgery at Dalhousie University. He is also a staff surgeon at Queen Elizabeth II Health Sciences Centre. Dr. Hirsch obtained his MD from Mount Sinai School of Medicine. He subsequently completed his residency training in General Surgery and Cardiothoracic Surgery from Massachusetts General Hospital, and a Research Fellowship in pathology from Harvard Medical School. Dr. Hirsch’s clinical research interests include outcomes assessment research for frail patients undergoing surgery and mechanisms that lead to donor organ rejections.

Ryan Gainer joined the Division of Cardiac Surgery at Nova Scotia Health Authority in 2010 as a research associate through Dalhousie University, focusing on patient-centered quality of care and outcomes research. A passionate advocate for patients rights, Gainer wants to continue his work in changing how informed consent in the healthcare system operates while he pursues his MSc in Community Health and Epidemiology at Dalhousie.