The modified frailty index-11 predicts medium-term outcomes after endovascular revascularisation for chronic limb threatening ischaemia in Asian patients

Abstract

Objective The aim was to evaluate the utility of frailty, as defined by the modified Frailty Index-1 1 (mFI-11) on predicting outcomes following endovascular revascularisation in Asian patients with chronic limb-threatening ischaemia (CLTI). Methods CLTI patients who underwent endovascular revascularisation between January 2015 and March 2017 were included. Patients were retrospectively scored using the mFI-11 to categorise frailty as low, medium or high risk. Observed outcomes included 30-day complication rate and unplanned readmissions, 1-, 6- and 12-month mortality, and ambulation status at 6- and 12 months post-intervention. Results A total of 233 patients (250 procedures) were included; 137 (58.8%) were males and the mean age was 69.0 (±10.7) years. 202/233 (86.7%) were diabetic and 196/233 (84.1%) had a prior diagnosis of peripheral arterial disease (PAD). The mean mFI-11 score was 4.2 (±1.5). 28/233 (12.0%), 155/233 (66.5%), and 50/233 (21.5%) patients were deemed low (mF-11 score 0–2), moderate (mFI-11 score 3–5) and high (mFI-11 score 5–7) frailty risk, respectively. High frailty was associated with an increased 12-month mortality (OR 8.54, 95% CI 1.05–69.5; p = 0.05), 30-day complication rate (OR 9.41, 95% CI 2.01–44.1; p < 0.01) and 30-day unplanned readmission (OR 5.06, 95% CI 1.06–24.2; p = 0.04). Furthermore, a high score was associated with a significantly worse 6- (OR 0.320, 95% CI 0.120–0.840; p = 0.02) and 12-month (OR 0.270, 95% CI 0.100–0.710; p < 0.01) ambulatory status. Conclusion The mFI-11 is a useful, non-invasive tool that can be readily calculated using readily available patient data, for prediction of medium-term outcomes for Asian CLTI patients following endovascular revascularisation. Early recognition of short- and mid-term loss of ambulation status amongst high-frailty patients in this challenging cohort of patients could aid decision-making for whether a revascularisation or amputation-first policy is appropriate, and manage patient and caregiver expectations on potential improvement in functional outcome.

Associations of Clinical Frailty with Severity of Limb Threat and Outcomes in Chronic Limb-threatening Ischaemia

“…8,10 Ongoing research may provide further useful information regarding assessment of frailty, physical function and cognitive impairment, as well as other outcomes such as quality of life and durability of revascularisation, in patients with CLTI. 34 Previous research has also demonstrated associations with frailty and outcomes over ≥1 year 3,4,[35][36][37] associated with worse overall survival and AFS at two-years, adjusting for tissue loss in their multivariable model. 3 Using the critical limb ischaemia (CLI) frailty index, a novel three-item frailty score, Morisaki et al (266 patients) showed an independent association of frailty with worse overall survival and AFS.…”

“…10,35,36 Soon et al (233 patients) used the modified frailty index (mFI) and also found an association of frailty with worse one-year mortality but not major amputation in CLTI. 37 However, the utility of the mFI as a frailty tool has been questioned. 10,30 Drudi et al utilised multiple frailty tools in patients undergoing revascularisation for claudication or CLTI (148 patients; 89 with CLTI).…”

“…4 None of these studies included patients managed non-operatively. 3,4,[35][36][37] No previously published research has reported the relationship of frailty with limb threat or polypharmacy in CLTI.…”

Distribution of Peripheral Arterial Disease in Patients Undergoing Endovascular Revascularization for Chronic Limb Threatening Ischaemia: Insights from the Vascular Quality Initiative in Singapore

“…Comparing to the endovascular Western cohorts from the SVS VQI registry [ 5 ], the Asian CLTI patient population was more complex, presenting with a higher incidence of comorbidities (84.5% vs. 56.2% diabetics, 54.7% vs. 8.2% CKD, respectively), a higher proportion of severely diseased lesions (78.9% vs. 22.5% TASC C-D, respectively), along with a higher proportion of patients with tissue loss (78.9% vs. 27.6%, respectively). The Singaporean (SG) cohort also appeared to have more comorbidities at baseline than their Asian counterparts in Taiwan (TW) and Japan (JP) (diabetes: SG 84.5%, TW 81%, JP 68%; hypertension: SG 90.6%, TW 85%, JP 81%) [ 6 ]. Comparing to data from the 2008 REACH registry, it is also evident that PAD is presenting later within the local population (mean age in 2008: 64.4±9.8 years vs. mean age in 2019: 67.9±11.0 years) [ 3 ].…”

Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia

“…To date, only a few small‐scale studies have examined the effects of various frailty measures on all‐cause mortality and AFS in patients with CLTI, but none are routinely used in clinical practice. 7 , 8 , 9 , 10 Frailty scores are calculated by assessing a set of variables such as activities of daily living, cognitive assessment, muscle mass, and nutrition. 7 , 8 , 9 , 10 These are relatively cumbersome, time‐ and resource‐consuming, subject to interobserver errors, and often impractical in relatively acute settings.…”