Considerations in Cardiac Revascularization for the Elderly Patient: Age Isn't Everything

Oneill, D.M.; Knudtson, Merril L.; Graham, Michelle M.

doi:10.1016/j.cjca.2016.05.003

Cited by 24 publications

(17 citation statements)

References 73 publications

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“…Hospitalization often leads to the impairment of functional performance and development in one-third of patients with disabilities, especially with problems with early activation of patients after medical procedures. When activating patients after cardiac surgery for an average of 43 min a day, there is a risk of losing 1-5% of muscle strength every day, which significantly increases the risk of developing disability, especially in patients with concomitant FS (O'Neill et al, 2016). The gait speed is a clinical marker of physical frailty, often used in cardiac surgery for predicting the risk of perioperative complications in elderly patients.…”

Section: Determinants Reduction In Physical Activitymentioning

confidence: 99%

Multidimensional Approach to Frailty

et al. 2020

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The concept of frailty syndrome (FS) was first described in the scientific literature three decades ago. For a very long time, we understood it as a geriatric problem, recently becoming one of the dominant concepts in cardiology. It identifies symptoms of FS in one in 10 elderly people. It is estimated that in Europe, 17% of elderly people have FS. The changes in FS resemble and often overlap with changes associated with the physiological aging process of the body. Although there are numerous scientific reports confirming that FS is age correlated, it is not an unavoidable part of the aging process and does not apply only to the elderly. FS is a reversible clinical condition. To maximize benefits of frailty-reversing activities for patient with frailty, identification of its determinants appears to be fundamental. Many of the determinants of the FS have already been known: reduction in physical activity, malnutrition, sarcopenia, polypharmacy, depressive symptom, cognitive disorders, and lack of social support. This review shows that insight into FS determinants is the starting point for building both the comprehensive definition of FS and the adoption of the assessment method of FS, and then successful clinical management.

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Section: Determinants Reduction In Physical Activitymentioning

confidence: 99%

Multidimensional Approach to Frailty

et al. 2020

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“…In fact, the Canadian Health Measures Study determined that the prevalence of frailty was 2% to 5% in those aged 18 to 34 years, 4% to 6% in those aged 35 to 49 years, 7% to 12% in those aged 50 to 64 years, and 8% to 20% in those aged 65þ years. 9 We tend to associate frailty with low body mass index because obese patients tend to have greater metabolic reserve and can cope better with catabolic stimuli seen in chronically advanced heart failure and acutely in cardiac surgery: This is referred to as the ''obesity paradox.'' 10 However, obese patients can also be frail, a phenomenon referred to as ''sarcopenic obesity.''…”

Section: What Is Frailty and Is It A Risk Predictor In Cardiac Surgery?mentioning

confidence: 99%

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Yanagawa

Graham

Afilalo

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…These referenced studies showed that the cost of hospitalization in older patients who undergo CABG are greater. The observed differences are mostly accounted by the extended hospital stay and higher incidence of postoperative complications (i.e., pneumonia, deep wound infections) (O’Neill et al, 2016; Toor et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

Risk factors for in-hospital mortality after coronary artery bypass grafting in patients 80 years old or older: a retrospective case-series study

Piątek

Kędziora

Konstanty-Kalandyk

et al. 2016

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BackgroundAge remains a significant and unmodifiable risk factor for cardiovascular diseases, and an increasing number of patients older than 80 years of age undergo Coronary Artery Bypass Grafting (CABG). Old age is also an independent risk factor for postoperative complications. The aim of this study is to describe the population of patients 80 years of age or older who underwent CABG procedure and to assess the mortality rate and risk factors for in-hospital mortality.MethodsA retrospective case-series study analyzing 388 consecutive patients aged 80 years of age or older who underwent isolated CABG procedure between 2010 and 2014 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow.ResultsIn-hospital mortality stood at 7%, compared to 3.4% for all isolated CABG procedures at our Institution. In an univariate logistic regression analysis, risk factors for in-hospital mortality were as follows: NYHA class (p = 0.005, OR 1.95, 95% CI [1.23–3.1]), prolonged mechanical ventilation (p < 0.001, OR 7.08, 95% CI [2.47–20.3]), rethoracotomy (p = 0.04, OR 3.31, 95% CI [1.04–10.6]), duration of the procedure and ECC (for every 10 min p = 0.01, OR 1.01, 95% CI [1.0–1.01]; p = 0.03, OR 1.01, 95% CI [1.0–1.02], respectively), PRBC, FFP, and PLT transfusion (for every unit transfused p = 0.004, OR 1.42, 95% CI [1.12–1.8]; p = 0.002, OR 1.55, 95% CI [1.18–2.04]; p = 0.009, OR 1.93, 95% CI [1.18–3.14], respectively). Higher LVEF (p = 0.02, OR 0.97, 95% CI [0.94–0.99]) and LIMA graft implantation (p = 0.04, OR 0.36, 95% CI [0.13–0.98) decreased the in-hospital mortality. Death before discharge was more often observed in patients with multiple risk factors for cardiovascular diseases (0–2 –5.7%; 3–7.4%, 4–26.6%; p = 0.03).ConclusionsOlder age is associated with higher in-hospital mortality after isolated CABG at our Institution. Risk stratification scores and individualized risk evaluation, centered on comorbidities, NYHA class and left ventricular function, should be assessed in all cases. Whenever suitable, LIMA grafts should be used. Prolonged procedure and ECC time worsen the short-term outcome. Elderly individuals should be closely monitored postoperatively and the care should be focused on excessive blood loss and respiratory failure.

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Considerations in Cardiac Revascularization for the Elderly Patient: Age Isn't Everything

Cited by 24 publications

References 73 publications

Multidimensional Approach to Frailty

Multidimensional Approach to Frailty

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Risk factors for in-hospital mortality after coronary artery bypass grafting in patients 80 years old or older: a retrospective case-series study

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