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Article: The prognostic impacts of frailty on clinical and patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures: A systematic review and meta-analysis

TitleThe prognostic impacts of frailty on clinical and patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures: A systematic review and meta-analysis
Authors
KeywordsCardiac surgical procedures
Frailty
Meta-analysis
Postoperative outcomes
Prognosis
Transcatheter aortic valve replacement
Issue Date11-Jan-2023
PublisherElsevier
Citation
Ageing Research Reviews, 2023, v. 85 How to Cite?
Abstract

Background

Frailty is emerging as an important prognostic indicator for patients undergoing cardiac surgeries/procedures. We sought to evaluate the prognostic and differential impacts of frailty on patients undergoing coronary artery or valvular surgical procedures of different levels of invasiveness, and to explore the differential predictability of various frailty measurement models.

Methods

Eight databases were searched for prospective cohort studies that have adopted validated measure(s) of frailty and reported clinical, healthcare service utilization, or patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures.

Results

Sixty-two articles were included (N = 16,679). Frailty significantly predicted mortality (short-term [≤ 30 days]: odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.28–4.26; midterm [6 months to 1 year]: OR: 3.93, 95%CI: 2.65–5.83; long-term [>1 year]: HR: 2.23, 95%CI: 1.60–3.11), postoperative complications (ORs: 2.54–3.57), discharge to care facilities (OR: 5.52, 95%CI: 3.84–7.94), hospital readmission (OR: 2.00, 95%CI: 1.15–3.50), and reduced health-related quality of life (HRQoL; standardized mean difference: −0.74, 95%CI: −1.30 to −0.18). Subgroup analyses showed that frailty exerted a greater impact on short-term mortality in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional and physical-aspect-focused frailty measurements performed equally in predicting mortality, but multidimensional measurements were more predictive of hospital readmission than physical-aspect-focused measurements.

Conclusion

Frailty was predictive of postoperative mortality, complications, increased healthcare service utilization, and reduced HRQoL. The impact of frailty on short-term mortality was more prominent in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional measures of frailty enhanced prognostic risk estimation, especially for hospital readmission.


Persistent Identifierhttp://hdl.handle.net/10722/330970
ISSN
2023 Impact Factor: 12.5
2023 SCImago Journal Rankings: 3.376
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWong, CWY-
dc.contributor.authorYu, DSF-
dc.contributor.authorLi, PWC-
dc.contributor.authorChan, BS-
dc.date.accessioned2023-09-21T06:51:39Z-
dc.date.available2023-09-21T06:51:39Z-
dc.date.issued2023-01-11-
dc.identifier.citationAgeing Research Reviews, 2023, v. 85-
dc.identifier.issn1568-1637-
dc.identifier.urihttp://hdl.handle.net/10722/330970-
dc.description.abstract<h3>Background</h3><p>Frailty is emerging as an important prognostic indicator for patients undergoing cardiac surgeries/procedures. We sought to evaluate the prognostic and differential impacts of frailty on patients undergoing coronary artery or valvular surgical procedures of different levels of invasiveness, and to explore the differential predictability of various frailty measurement models.</p><h3>Methods</h3><p>Eight databases were searched for prospective cohort studies that have adopted validated measure(s) of frailty and reported clinical, healthcare service utilization, or patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures.</p><h3>Results</h3><p>Sixty-two articles were included (<em>N</em> = 16,679). Frailty significantly predicted mortality (short-term [≤ 30 days]: odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.28–4.26; midterm [6 months to 1 year]: OR: 3.93, 95%CI: 2.65–5.83; long-term [>1 year]: HR: 2.23, 95%CI: 1.60–3.11), postoperative complications (ORs: 2.54–3.57), discharge to care facilities (OR: 5.52, 95%CI: 3.84–7.94), hospital readmission (OR: 2.00, 95%CI: 1.15–3.50), and reduced health-related quality of life (HRQoL; standardized mean difference: −0.74, 95%CI: −1.30 to −0.18). Subgroup analyses showed that frailty exerted a greater impact on short-term mortality in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional and physical-aspect-focused frailty measurements performed equally in predicting mortality, but multidimensional measurements were more predictive of hospital readmission than physical-aspect-focused measurements.</p><h3>Conclusion</h3><p>Frailty was predictive of postoperative mortality, complications, increased healthcare service utilization, and reduced HRQoL. The impact of frailty on short-term mortality was more prominent in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional measures of frailty enhanced prognostic risk estimation, especially for hospital readmission.</p>-
dc.languageeng-
dc.publisherElsevier-
dc.relation.ispartofAgeing Research Reviews-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectCardiac surgical procedures-
dc.subjectFrailty-
dc.subjectMeta-analysis-
dc.subjectPostoperative outcomes-
dc.subjectPrognosis-
dc.subjectTranscatheter aortic valve replacement-
dc.titleThe prognostic impacts of frailty on clinical and patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures: A systematic review and meta-analysis-
dc.typeArticle-
dc.identifier.doi10.1016/j.arr.2023.101850-
dc.identifier.scopuseid_2-s2.0-85146162084-
dc.identifier.volume85-
dc.identifier.eissn1872-9649-
dc.identifier.isiWOS:000923794000001-
dc.identifier.issnl1568-1637-

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