Laura M Drudi1, Matthew Ades2, Rita Mancini3, Catherine Boudrias3, Daniel I Obrand4, Oren K Steinmetz4, Jonathan Afilalo5. 1. Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Montreal, Quebec, Canada. Electronic address: laura.drudi@mail.mcgill.ca. 2. Department of Internal Medicine, McGill University, Montreal, Quebec, Canada. 3. Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Montreal, Quebec, Canada. 4. Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada. 5. Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Montreal, Quebec, Canada; Division of Cardiology, Jewish General Hospital, Montreal, Quebec, Canada.
Abstract
OBJECTIVE: Frailty is a multidimensional syndrome that influences postoperative morbidity and mortality after vascular procedures; however, its integration in clinical practice has been limited, given the lack of consensus on how to measure it. This study sought to compare the incremental predictive value of six different nonphysical performance frailty scales to predict poor outcomes after interventions for peripheral arterial disease (PAD). METHODS: This preplanned analysis of the FRailty Assessment In Lower Extremity arterial Disease (FRAILED) prospective cohort included two centers recruiting patients between July 1, 2015, and October 1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled. The following scales were compared: Edmonton Frail Scale, Groningen Frailty Indicator (GFI), modified Essential Frailty Toolset (mEFT), modified Frailty Index, Multidimensional Prognostic Index, and the Risk Analysis Index-C. The primary end point was a composite of all-cause mortality and major disability at 12 months after the procedure. The secondary end point was length of stay. Logistic regression was used to determine the association of frailty with the primary end point after adjusting for confounders. To compare the incremental predictive value of each frailty scale, model performance statistics were calculated. RESULTS: The cohort was composed of 148 patients with a mean age of 70 years. Depending on the scale used, the prevalence of frailty ranged from 16% to 70%. Frailty as measured by the GFI (adjusted odds ratio, 1.76; 95% confidence interval, 1.14-2.72) and mEFT (adjusted odds ratio, 2.71; 95% confidence interval, 1.29-5.73) predicted mortality and worsening disability at 12 months after interventions for PAD. Furthermore, there was statistically significant C-statistic, Bayesian information criterion, and integrated discrimination improvement when the GFI and mEFT were added to the baseline model. Frailty was not associated with length of stay. CONCLUSIONS: Frailty is associated with mortality and worsening disability after interventions for PAD. The GFI and mEFT performed well and identified vulnerable older adults who are at risk of poor outcomes after interventions for PAD and recommended for use in this setting.
OBJECTIVE: Frailty is a multidimensional syndrome that influences postoperative morbidity and mortality after vascular procedures; however, its integration in clinical practice has been limited, given the lack of consensus on how to measure it. This study sought to compare the incremental predictive value of six different nonphysical performance frailty scales to predict poor outcomes after interventions for peripheral arterial disease (PAD). METHODS: This preplanned analysis of the FRailty Assessment In Lower Extremity arterial Disease (FRAILED) prospective cohort included two centers recruiting patients between July 1, 2015, and October 1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled. The following scales were compared: Edmonton Frail Scale, Groningen Frailty Indicator (GFI), modified Essential Frailty Toolset (mEFT), modified Frailty Index, Multidimensional Prognostic Index, and the Risk Analysis Index-C. The primary end point was a composite of all-cause mortality and major disability at 12 months after the procedure. The secondary end point was length of stay. Logistic regression was used to determine the association of frailty with the primary end point after adjusting for confounders. To compare the incremental predictive value of each frailty scale, model performance statistics were calculated. RESULTS: The cohort was composed of 148 patients with a mean age of 70 years. Depending on the scale used, the prevalence of frailty ranged from 16% to 70%. Frailty as measured by the GFI (adjusted odds ratio, 1.76; 95% confidence interval, 1.14-2.72) and mEFT (adjusted odds ratio, 2.71; 95% confidence interval, 1.29-5.73) predicted mortality and worsening disability at 12 months after interventions for PAD. Furthermore, there was statistically significant C-statistic, Bayesian information criterion, and integrated discrimination improvement when the GFI and mEFT were added to the baseline model. Frailty was not associated with length of stay. CONCLUSIONS: Frailty is associated with mortality and worsening disability after interventions for PAD. The GFI and mEFT performed well and identified vulnerable older adults who are at risk of poor outcomes after interventions for PAD and recommended for use in this setting.
Authors: Alberto Pilotto; Carlo Custodero; Stefania Maggi; Maria Cristina Polidori; Nicola Veronese; Luigi Ferrucci Journal: Ageing Res Rev Date: 2020-03-21 Impact factor: 10.895
Authors: Artur Kotov; Deven A Blasche; Frederik Peters; Philip Pospiech; Ulrich Rother; Konstantinos Stavroulakis; Jürgen Remig; Christian Schmidt-Lauber; Thomas Zeller; Hartmut Görtz; Jörg Teßarek; Christian-Alexander Behrendt Journal: J Clin Med Date: 2022-08-14 Impact factor: 4.964
Authors: Evelien E Quint; Lasse Schopmeyer; Louise B D Banning; Cyril Moers; Mostafa El Moumni; Gertrude J Nieuwenhuijs-Moeke; Stefan P Berger; Stephan J L Bakker; Robert A Pol Journal: Langenbecks Arch Surg Date: 2020-07-20 Impact factor: 3.445