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

Wong, Cathy W Y; Yu, Doris S.F.; Li, Polly W.C.; Chan, Bernice Shinyi

doi:10.1016/j.arr.2023.101850

Cited by 8 publications

(5 citation statements)

References 105 publications

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“…Frailty analysis is a crucial investigation to promote cardiac rehabilitation in patients undergoing valve replacement ( 46 ). Wong et al ( 47 ) reported that frailty is an essential factor for predicting mortality and complications among patients undergoing heart surgery, including valve replacement. Early identification and management of frailty are critical measures for mitigating mortality and improving the quality of life of patients ( 48 ).…”

Section: Discussionmentioning

confidence: 99%

Effective health management strategies for patients undergoing valve replacement: a bibliometric analysis of the current research status and future directions

Wang,

Wu,

et al. 2024

Front. Cardiovasc. Med.

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BackgroundValvular heart disease is a major health concern worldwide. The effective management of patients undergoing valve replacement determines their prognosis. Bibliometric analysis of studies on managing patients with artificial heart valves has not been previously performed.MethodsThis study analyzed 2,771 publications related to patient management after valve replacement published in the Web of Science Core Collection database between January 1, 2013, and December 31, 2022. Bibliometric analysis was performed using CiteSpace and VOSviewer considering countries, institutions, authors, journals, references, and keywords.ResultsThe countries with the most significant contributions in this field were the United States of America (USA), Germany, and Italy. Leon MB from Columbia University, USA was the most influential author. Transcatheter aortic valve replacement was a current research hotspot, while anticoagulation management was a key area of interest. Combining anticoagulation therapy with internet-linked tools and portable health devices may offer new research avenues. Frailty assessment and intervention were potential future research areas.ConclusionsThis bibliometric analysis provides clinicians and researchers with useful insights for developing novel ideas and directions to manage the health of patients undergoing valve replacement.

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Section: Discussionmentioning

confidence: 99%

Effective health management strategies for patients undergoing valve replacement: a bibliometric analysis of the current research status and future directions

Wang,

Wu,

et al. 2024

Front. Cardiovasc. Med.

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“… 41 , 42 A recent systematic review and meta‐analysis of cardiac surgery patients reported that frailty was identified as a key predictor associated with increased short‐ and long‐term mortality, increased postoperative complications, increased rates of transition to nursing facilities, increased risk of readmission, and decreased health‐related quality of life after surgery. 43 Previous studies have examined the association between frailty and delirium in patients after cardiac surgery and found an increased risk of POD due to frailty. 16 , 17 , 44 However, these studies were limited by sample size.…”

Section: Discussionmentioning

confidence: 99%

“…While it is widely accepted that health challenges increase with age, what is more compelling is that frailty may predict morbidity and mortality after surgery in the elderly more accurately than chronological age 41,42 . A recent systematic review and meta‐analysis of cardiac surgery patients reported that frailty was identified as a key predictor associated with increased short‐ and long‐term mortality, increased postoperative complications, increased rates of transition to nursing facilities, increased risk of readmission, and decreased health‐related quality of life after surgery 43 . Previous studies have examined the association between frailty and delirium in patients after cardiac surgery and found an increased risk of POD due to frailty 16,17,44 .…”

Section: Discussionmentioning

confidence: 99%

Association between modified frailty index and postoperative delirium in patients after cardiac surgery: A cohort study of 2080 older adults

Cheng,

Ling,

et al. 2024

CNS Neurosci Ther

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AimTo evaluate the association between frailty and postoperative delirium (POD) in elderly cardiac surgery patients.MethodsA retrospective study was conducted of older patients admitted to the intensive care unit after cardiac surgery at a tertiary academic medical center in Boston from 2008 to 2019. Frailty was measured using the Modified Frailty Index (MFI), which categorized patients into frail (MFI ≥3) and non‐frail (MFI = 0–2) groups. Delirium was identified using the confusion assessment method for the intensive care unit and nursing notes. Logistic regression models were used to examine the association between frailty and POD, and odds ratios (OR) with 95% confidence intervals (CI) were calculated.ResultsOf the 2080 patients included (median age approximately 74 years, 30.9% female), 614 were frail and 1466 were non‐frail. The incidence of delirium was significantly higher in the frail group (29.2% vs. 16.4%, p < 0.05). After adjustment for age, sex, race, marital status, Acute Physiology Score III (APSIII), sequential organ failure assessment (SOFA), albumin, creatinine, hemoglobin, white blood cell count, type of surgery, alcohol use, smoking, cerebrovascular disease, use of benzodiazepines, and mechanical ventilation, multivariate logistic regression indicated a significantly increased risk of delirium in frail patients (adjusted OR: 1.61, 95% CI: 1.23–2.10, p < 0.001, E‐value: 1.85).ConclusionsFrailty is an independent risk factor for POD in older patients after cardiac surgery. Further research should focus on frailty assessment and tailored interventions to improve outcomes.

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“…Frailty is an aging‐related syndrome of physiological decline and is known as an independent predictive marker of mortality and morbidity in patients with cardiovascular disease as well as in general elderly population. 20 , 21 , 22 Frailty is common in TAVR recipients given the overall higher age and comorbidities. 23 In this regard, the level of frailty may be different between the TF‐TAVR with PVI and non‐TF‐TAVR groups, affecting outcomes.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Outcomes Following Transcatheter Aortic Valve Replacement Requiring Peripheral Vascular Intervention or Alternative Access

Isogai

Agrawal

Shekhar

et al. 2023

JAHA

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Background Peripheral vascular intervention (PVI) is occasionally required to facilitate delivery system insertion or to treat vascular complications during transfemoral transcatheter aortic valve replacement (TF‐TAVR). However, the impact of PVI on outcomes is not well understood. Therefore, we aimed to compare outcomes between TF‐TAVR with versus without PVI and between TF‐TAVR with PVI versus non‐TF‐TAVR. Methods and Results We retrospectively reviewed 2386 patients who underwent TAVR with a balloon‐expandable valve at a single institution from 2016 to 2020. The primary outcomes were death and major adverse cardiac/cerebrovascular event (MACCE), defined as death, myocardial infarction, or stroke. Of 2246 TF‐TAVR recipients, 136 (6.1%) required PVI (89% bailout treatment). During follow‐up (median 23.0 months), there were no significant differences between TF‐TAVR with and without PVI in death (15.4% versus 20.7%; adjusted HR [aHR], 0.96 [95% CI, 0.58–1.58]) or MACCE (16.9% versus 23.0%; aHR, 0.84 [95% CI, 0.52–1.36]). However, compared with non‐TF‐TAVR (n=140), TF‐TAVR with PVI carried significantly lower rates of death (15.4% versus 40.7%; aHR, 0.42 [95% CI, 0.24–0.75]) and MACCE (16.9% versus 45.0%; aHR, 0.40 [95% CI, 0.23–0.68]). Landmark analyses demonstrated lower outcome rates following TF‐TAVR with PVI than non‐TF‐TAVR both within 60 days (death 0.7% versus 5.7%, P =0.019; MACCE 0.7% versus 9.3%; P =0.001) and thereafter (death 15.0% versus 38.9%, P =0.014; MACCE 16.5% versus 41.3%, P =0.013). Conclusions The need for PVI during TF‐TAVR is not uncommon, mainly due to the bailout treatment for vascular complications. PVI is not associated with worse outcomes in TF‐TAVR recipients. Even when PVI is required, TF‐TAVR is associated with better short‐ and intermediate‐term outcomes than non‐TF‐TAVR.

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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

Cited by 8 publications

References 105 publications

Effective health management strategies for patients undergoing valve replacement: a bibliometric analysis of the current research status and future directions

Effective health management strategies for patients undergoing valve replacement: a bibliometric analysis of the current research status and future directions

Association between modified frailty index and postoperative delirium in patients after cardiac surgery: A cohort study of 2080 older adults

Comparison of Outcomes Following Transcatheter Aortic Valve Replacement Requiring Peripheral Vascular Intervention or Alternative Access

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