Dae Hyun Kim, MD, MPH, ScD; Caroline A. Kim, MD, MS, MPH; Sebastian Placide, BA; Lewis A. Lipsitz, MD; Edward R. Marcantonio, MD, ScM
Earlier versions of this work were presented as a poster at the Gerontological Society of America Annual Meeting, Washington, DC, in November 2014, and at the American Geriatrics Society Annual Meeting, National Harbor, Maryland, in May 2015.
Note: Dr. D.H. Kim had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Grant Support: Dr. D.H. Kim is supported by the Paul B. Beeson Clinical Scientist Development Award in Aging (K08AG051187) from the National Institute on Aging, American Federation for Aging Research, The John A. Hartford Foundation, and The Atlantic Philanthropies. Dr. C.A. Kim is supported by a Training Program in Cardiovascular Research grant (T32-HL007374) from the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Lipsitz is supported by grants R01AG025037 and R01AG041785 from the National Institute on Aging; he also holds the Irving and Edyth S. Usen and Family Chair in Geriatric Medicine at Hebrew SeniorLife. Dr. Marcantonio is supported by the following grants, all from the National Institute on Aging: P01AG03172, R01AG030618, R01AG051658, and K24AG035075.
Disclosures: Dr. D.H. Kim reports personal fees from the Alosa Foundation and grants from the National Institute on Aging, American Federation for Aging Research, John A. Hartford Foundation, and Atlantic Philanthropies, outside the submitted work. Dr. C.A. Kim reports a Training Program in Cardiovascular Research grant from the National Heart, Lung, and Blood Institute, National Institutes of Health during the conduct of the study. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0652.
Reproducible Research Statement: Study protocol: See Supplement 1. Statistical code: Not applicable. Data set: See Supplement 2.
Requests for Single Reprints: Dae Hyun Kim, MD, MPH, ScD, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 1A, Boston, MA 02215; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. D.H. Kim, C.A. Kim, and Lipsitz: Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 1A, Boston, MA 02215.
Mr. Placide: Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.
Dr. Marcantonio: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-216, Boston, MA 02215.
Author Contributions: Conception and design: D.H. Kim, C.A. Kim, E.R. Marcantonio.
Analysis and interpretation of the data: D.H. Kim, C.A. Kim.
Drafting of the article: D.H. Kim, C.A. Kim, L.A. Lipsitz.
Critical revision for important intellectual content: D.H. Kim, C.A. Kim, L.A. Lipsitz, E.R. Marcantonio.
Final approval of the article: D.H. Kim, C.A. Kim, L.A. Lipsitz, S. Placide, E.R. Marcantonio.
Provision of study materials or patients: C.A. Kim.
Obtaining of funding: C.A. Kim, L.A. Lipsitz.
Administrative, technical, or logistic support: C.A. Kim, S. Placide.
Collection and assembly of data: D.H. Kim, C.A. Kim, S. Placide.
Frailty assessment may inform surgical risk and prognosis not captured by conventional surgical risk scores.
To evaluate the evidence for various frailty instruments used to predict mortality, functional status, or major adverse cardiovascular and cerebrovascular events (MACCEs) in older adults undergoing cardiac surgical procedures.
MEDLINE and EMBASE (without language restrictions), from their inception to 2 May 2016.
Cohort studies evaluating the association between frailty and mortality or functional status at 6 months or later in patients aged 60 years or older undergoing major or minimally invasive cardiac surgical procedures.
2 reviewers independently extracted study data and assessed study quality.
Mobility, disability, and nutrition were frequently assessed domains of frailty in both types of procedures. In patients undergoing major procedures (n = 18 388; 8 studies), 9 frailty instruments were evaluated. There was moderate-quality evidence to assess mobility or disability and very-low- to low-quality evidence for using a multicomponent instrument to predict mortality or MACCEs. No studies examined functional status. In patients undergoing minimally invasive procedures (n = 5177; 17 studies), 13 frailty instruments were evaluated. There was moderate- to high-quality evidence for assessing mobility to predict mortality or functional status. Several multicomponent instruments predicted mortality, functional status, or MACCEs, but the quality of evidence was low to moderate. Multicomponent instruments that measure different frailty domains seemed to outperform single-component ones.
Heterogeneity of frailty assessment, limited generalizability of multicomponent frailty instruments, few validated frailty instruments, and potential publication bias.
Frailty status, assessed by mobility, disability, and nutritional status, may predict mortality at 6 months or later after major cardiac surgical procedures and functional decline after minimally invasive cardiac surgery.
National Institute on Aging and National Heart, Lung, and Blood Institute.
Kim DH, Kim CA, Placide S, Lipsitz LA, Marcantonio ER. Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures: A Systematic Review. Ann Intern Med. [Epub ahead of print 23 August 2016]165:650–660. doi: 10.7326/M16-0652
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Published: Ann Intern Med. 2016;165(9):650-660.
Published at www.annals.org on 23 August 2016
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