Abstract 207: Assessing the Clinical Value of Frailty as a Prognostic Indicator to Aid Decision-Making in Cardiac Surgery


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Abstract

Background: In North America, octogenarians are the fastest growing demographic. Chronological age of a patient is not always the same as their biological age, and their biological status can vary from robust to frail. Frail patients are predisposed to falls, institutionalization, hospitalization, and mortality. In the realm of cardiac surgery, there is little research examining frailty as a prognostic factor for cardiac surgical intervention.Purpose: The objective of the current study is to explore whether frailty provides additional information as a risk factor regarding patient prognosis over and above that of the comprehensive risk analysis scale, EuroSCORE II, used to determine suitability for cardiac surgery.Methods: This non-interventional study uses hospital patient files and questionnaire interviews, which assesses the patient’s frailty using the Frailty Assessment for Care-Planning Tool (FACT). From the documented EuroSCORE II from patient files, predictive modeling was used to consider frailty as a prognostic indicator for three adverse outcomes, discharge to an institution, major adverse cardiac events (MACE), and all-cause mortality + MACE. Furthermore, the sensitivity and specificity of the FACT will be evaluated using the area under the ROC curve for significant models.Results: Prognostic models determined that AUROC values provide improved prediction for two adverse outcomes, MACE and all-cause mortality + MACE. Using a cumulative score that involves all four domains (usual mobility, daily tasks, social function, and memory), higher discrimination with good calibration is achieved.Conclusions: Certain aspects of frailty, as measured by the FACT, have clinical value as prognostic indicators. These models are the first, to our knowledge, to investigate the relationship between the EuroSCORE II and MACE +/- all-cause mortality using the FACT. Traditional risk assessment scores such as the EuroSCORE II will benefit from having frailty included as a risk factor.Implications: This study will assist in educating future heart surgery patients about their possible risks by predicting adverse outcomes with better predictive ability. It is hoped that patients who possess more knowledge about their personal risks will be able to make more informed decisions about their surgery. Strategies to address and reduce frailty by increasing mobility and cognitive function and reducing nutritional deficiencies could use this information to inform future work.

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