Javier Miguelena-Hycka1, Jose Lopez-Menendez2, Pablo-Cesar Prada3, Jorge Rodriguez-Roda2, Miren Martin2, Carlota Vigil-Escalera4, Daniel Hernandez-Vaquero4, Jose M Miguelena5, Jacobo Silva4, Magali Gonzalez-Colaço6. 1. Department of Cardiac Surgery, Ramon y Cajal University Hospital, Madrid, Spain. Electronic address: jmiguelena@hotmail.com. 2. Department of Cardiac Surgery, Ramon y Cajal University Hospital, Madrid, Spain. 3. Department of Cardiac Surgery, University Hospital of Canary Islands, Santa Cruz de Tenerife, Spain. 4. Department of Cardiac Surgery, Asturias Central University Hospital, Oviedo, Spain. 5. Department of Surgery, Zaragoza University, Zaragoza, Spain. 6. Clinical Trials and Clinical Research Unit, University Hospital of Canary Islands, Santa Cruz de Tenerife, Spain.
Abstract
BACKGROUND: Frailty has emerged as one of the main predictors of worse outcomes after cardiac surgery, but scarce evidence is available about its influence on postoperative quality of life. Whether frail patients may improve their quality of life or not after the surgical procedure is a matter that still remains unclear. METHODS: This observational and multicenter cohort study was conducted in 3 university-affiliated hospitals of three different regions of Spain (Madrid, Asturias, and Canary Islands). Patients were categorized into three ordinal levels of frailty (frail, prefrail, robust) using the Fried, FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, and Clinical Frailty Scale frailty scales. We analyzed the changes on health-related quality-of-life for each level of frailty using the EuroQoL 5-Dimension 5 Level questionnaire before and 6 months after the operation. RESULTS: The study included 137 patients, and 109 completed the 6-month follow-up. Median age of the entire cohort was 78 years (interquartile interval, 72 to 83 years). Frailty prevalence varied between 10% and 29%, depending on which scale was used. There was a statistically significant linear trend in the incidence of death or major morbidity among the different levels of frailty. On one hand, robust patients did not show significant changes in their previously high score of quality of life during follow-up. On the other hand, frail and prefrail patients significantly improved their scores after the operation. These results were comparable regardless the scale used for frailty assessment. CONCLUSIONS: Frail and prefrail patients have a significant improvement in their quality of life 6 months after their cardiac operation, and they have a proportionally greater increase in their postoperative health-related quality of life scores than robust patients.
BACKGROUND: Frailty has emerged as one of the main predictors of worse outcomes after cardiac surgery, but scarce evidence is available about its influence on postoperative quality of life. Whether frail patients may improve their quality of life or not after the surgical procedure is a matter that still remains unclear. METHODS: This observational and multicenter cohort study was conducted in 3 university-affiliated hospitals of three different regions of Spain (Madrid, Asturias, and Canary Islands). Patients were categorized into three ordinal levels of frailty (frail, prefrail, robust) using the Fried, FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, and Clinical Frailty Scale frailty scales. We analyzed the changes on health-related quality-of-life for each level of frailty using the EuroQoL 5-Dimension 5 Level questionnaire before and 6 months after the operation. RESULTS: The study included 137 patients, and 109 completed the 6-month follow-up. Median age of the entire cohort was 78 years (interquartile interval, 72 to 83 years). Frailty prevalence varied between 10% and 29%, depending on which scale was used. There was a statistically significant linear trend in the incidence of death or major morbidity among the different levels of frailty. On one hand, robust patients did not show significant changes in their previously high score of quality of life during follow-up. On the other hand, frail and prefrail patients significantly improved their scores after the operation. These results were comparable regardless the scale used for frailty assessment. CONCLUSIONS: Frail and prefrail patients have a significant improvement in their quality of life 6 months after their cardiac operation, and they have a proportionally greater increase in their postoperative health-related quality of life scores than robust patients.
Authors: Britt Borregaard; Jordi S Dahl; Sandra B Lauck; Jesper Ryg; Selina K Berg; Ola Ekholm; Jeroen M Hendriks; Lars P S Riber; Tone M Norekvål; Jacob E Møller Journal: Int J Cardiol Heart Vasc Date: 2020-11-13
Authors: Carmel Montgomery; Henry Stelfox; Colleen Norris; Darryl Rolfson; Steven Meyer; Mohamad Zibdawi; Sean Bagshaw Journal: CMAJ Open Date: 2021-07-20