Breaking News
October 17, 2018 - Health Tip: Know the Risks of Chicken Pox
October 17, 2018 - Immunotherapy effective against hereditary melanoma
October 17, 2018 - Researchers reveal new mechanism for how animal cells stay intact | News Center
October 17, 2018 - Alzheimer's Goes Under the Cryo-Electron Microscope
October 17, 2018 - Medicare for all? CMS chief warns program has enough problems already
October 17, 2018 - Metrohm Raman introduces Mira P handheld Raman system
October 17, 2018 - Expanding the knowledge about hippocampus to better understand cognitive deficits in MS
October 17, 2018 - Study of Nigerian breast cancer patients reveals prevalence of aggressive molecular features
October 17, 2018 - Many healthy children may have metabolic risk factors, finds study
October 17, 2018 - A new antibiotic could be a better, faster treatment for tuberculosis
October 17, 2018 - “I will not become a Robot Doctor”: A medical student vows to practice compassion
October 17, 2018 - Study findings may explain sporadic outbreaks of C. difficile infections in hospitals
October 17, 2018 - Purdue researchers develop new chemical process to find better drug ‘fits’ for patients
October 17, 2018 - Yale researchers develop way to attack RNA with small-molecule drugs
October 17, 2018 - New pragmatic study launched to understand the effectiveness of new type 2 diabetes drug
October 17, 2018 - Alnylam Announces Plan to Initiate Rolling Submission of a New Drug Application and Pursue Full Approval for Givosiran
October 17, 2018 - Nine cases of polio-like illness suspected in children in illinois
October 17, 2018 - Eisai enters into agreement with Eurofarma for development and sales of lorcaserin in 17 countries
October 17, 2018 - Patients once thought incurable can benefit from high-dose radiation therapy
October 17, 2018 - Researchers awarded grant to advance testing of experimental heroin vaccine
October 17, 2018 - Researchers examine SSRI use during pregnancy and major gestational malformations
October 17, 2018 - Study reveals link between childhood abuse and higher arthritis risk in adulthood
October 17, 2018 - Research shows people over 65 are not performing enough physical activity
October 17, 2018 - FDA Approves Liletta (levonorgestrel-releasing intrauterine system) 52 mg to Prevent Pregnancy for up to Five Years
October 17, 2018 - Weight gain after smoking cessation linked to increased short-term diabetes risk
October 17, 2018 - Researchers find opportunity to control salt-sensitive hypertension without exercising
October 17, 2018 - Women not warned about cancer associated with breast implants
October 17, 2018 - Metrohm offers robust handheld Raman analyzer for Defense and Security
October 17, 2018 - Modeling Non-Numerical Data in Systems Biology
October 17, 2018 - Research aims to address health disparities in African-American men
October 17, 2018 - Human and cattle decoys trap outdoor-biting mosquitoes in malaria endemic regions
October 17, 2018 - High Circulating Prolactin Level Inversely Linked to T2DM Risk
October 17, 2018 - Study finds gene variant predisposes people to both Type 2 diabetes and low body weight
October 17, 2018 - Metrohm software products make it easy to comply with ALOCA and ALCOA+ guidelines
October 17, 2018 - Network of doctors identify the cause of 31 new conditions
October 17, 2018 - Notable improvement in brain cancer survival among younger patients but not much for elderly
October 17, 2018 - Scientists shed light on roles of transcription factors, TP63 and SOX2, in squamous cell carcinoma
October 17, 2018 - Costs of Medicare Diabetes Prevention Program may be higher than expected reimbursement
October 17, 2018 - Misuse of prescription opioids or benzodiazepines associated with suicidal thoughts
October 17, 2018 - New research seeks to address sex disparities in women’s health
October 17, 2018 - C-Section Rates Have Nearly Doubled Since 2000: Study
October 17, 2018 - Talking to Your Kids About STDs
October 17, 2018 - New classification of periodontal and peri-implant diseases and conditions
October 17, 2018 - Herbert D. Kleber, Pioneer in Addiction Treatment, Dies at 84
October 17, 2018 - Health effects of smoke-filled atmosphere
October 17, 2018 - Down syndrome may hold important clues to onset of Alzheimer’s disease
October 17, 2018 - A special report on US’ aging societies
October 17, 2018 - Birth mode may have acute effects on neurodevelopment, study suggests
October 17, 2018 - Global health innovation system fails to deliver affordable treatments to patients, says report
October 17, 2018 - Simple, inexpensive test quickly detects antibiotic-resistant ‘superbugs’
October 17, 2018 - New drugs could reduce risk of heart disease when added to statins
October 17, 2018 - Visible and valued: Stanford Medicine’s first-ever LGBTQ+ Forum
October 17, 2018 - HVP vaccination not linked with rise in teen risky sex
October 17, 2018 - Potential ‘early warning markers’ for sepsis discovered
October 17, 2018 - Who knew? Life begins (again) at 65
October 17, 2018 - Application of blood pressure guidelines ups treatment
October 17, 2018 - Stanford researchers find that small molecule may help treat enzyme deficiency
October 17, 2018 - Speed Cameras Save Money and Lives in New York City
October 17, 2018 - Men who conform to ‘the man box’ more likely to consider suicide and violence
October 17, 2018 - Researchers aim to create more authentic organoids for drug testing, transplantation
October 16, 2018 - New blood test for pediatric brain tumor patients offers safer approach than surgical biopsies
October 16, 2018 - Age-related estrogen increase may be the culprit behind inguinal hernias in men
October 16, 2018 - Skills-Based Intervention Did Not Cut Systolic BP After Stroke, TIA
October 16, 2018 - Researchers uncover new role of TIP60 protein in controlling tumour formation
October 16, 2018 - Behind the scenes of a lifesaving heart surgery
October 16, 2018 - ‘To See the Suffering’
October 16, 2018 - Drinking concentrated rosemary extract can boost memory by up to 15%, shows research
October 16, 2018 - Medicare Advantage riding high as new insurers flock to sell to seniors
October 16, 2018 - NHS tackles prescription fraud to save millions
October 16, 2018 - New molecular switch may help develop sophisticated photomedications
October 16, 2018 - Improving access to behavioral health screenings for pregnant and postpartum women
October 16, 2018 - Health Highlights: Oct. 12, 2018
October 16, 2018 - Study holds promise for new pediatric brain tumor treatment
October 16, 2018 - Patient advocate uses MRI scans to create art and spark conversations about life with illness
October 16, 2018 - Fish oil based diets may suppress growth and spread of breast cancer cells
October 16, 2018 - Number of VHA facilities offering acupuncture has increased rapidly
October 16, 2018 - Influential Leapfrog Group jumps in to rate 5,600 surgery centers
October 16, 2018 - HIV-infected infants more likely to acquire congenital cytomegalovirus infection
October 16, 2018 - Study pinpoints new marker that can predict Crohn’s disease subtype
October 16, 2018 - Simple procedure could be efficacious intervention for failed back surgery
Frailty associated with poor survival rates in young heart patients

Frailty associated with poor survival rates in young heart patients

image_pdfDownload PDFimage_print

Traditionally, frailty is thought to be a syndrome of the elderly – one which comes as a natural and inevitable side-effect of aging, gradually transforming strong, healthy bodies into weaker, more delicate frames over time. For clinicians, frailty is a concept which has long posed formidable challenges in perioperative medicine. For patients, frailty turns even the most routine operative procedures into complicated life or death undertakings.

It is well known to science that chronological frailty, that is the degradation of the human body associated with a person’s actual age, is commonly linked to increased mortality, surgical site infections, length of hospital stay, increased healthcare expenditure and readmission rates in patients presenting for a variety of major non-cardiac surgeries. However, similar literature with regard to frailty in patients undergoing heart surgery remains scarce despite its rise in prevalence.

A new study conducted by researchers at the University of Ottawa Heart Institute and published in the Journal of the American Heart Association examines the prevalence of frailty and its association with long-term mortality in patients undergoing cardiac surgery. More specifically, the study, titled Association of Frailty and Long-Term Survival in Patients Undergoing Coronary Artery Bypass Grafting (CABG) followed patients over the age of 40 who underwent primary isolated CABG, a common surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. Researchers examined administrative healthcare data from the Institute for Clinical Evaluative Science (ICES) and the clinical registry data from CorHealth Ontario to support their findings.

A total of 40,083 consecutive patients in Ontario who underwent isolated CABG between 2008 and 2015 were included in the study. It found the prevalence of frailty was markedly higher in patients undergoing isolated CABG, at 22%, compared to those undergoing a planned non-cardiac surgery, at just 3%, which suggests that patients undergoing cardiac surgery are a more complex population who are at higher risk of complications. Frailty was also associated with poor early and long-term survival rates – especially in patients between the ages of 40 and 74. The adjusted long-term frailty-related mortality risk was inversely proportional to age, meaning after taking other comorbidities into consideration, frailty had a higher impact on the survival of younger patients.

“To our knowledge, this is the largest cohort study to describe the long-term outcomes of frailty in patients undergoing CABG surgery,” writes the study’s principal investigator, Dr. Louise Sun, a clinician investigator and staff anesthesiologist in the Division of Cardiac Anesthesiology at the University of Ottawa Heart Institute and an adjunct ICES scientist. “Interestingly, however, our study found the presence of frailty-defining diagnoses was a stronger predictor of mortality in younger patients.”

According to the study, frailty contributed to greater differences in the survival of patients between 40 and 74 years of age and smaller differences in the long-term survival of those 85 years or older, writes Dr. Sun. “What the science is telling us is that frailty poses a higher risk of mortality in younger patients and has a lower impact on older ones.”

Researchers used the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator to define frailty for the purpose of this study. This comprehensive tool provides a multi-dimensional snapshot of a patient’s physical status. It assesses frailty based on 10 clusters of frailty-defining diagnoses: malnutrition, dementia, impaired vision, decubitus ulcer, incontinence of urine, loss of weight, poverty, barriers to access to care, difficulty in walking, and falls.

Dr. Sun believes these recent findings highlight the importance of the concept of chronological aging versus physiological aging (a relative measure of a person’s age based on a number of physiological factors) in the prognosis of surgical patients. She says her team’s findings indicate age alone does not predict outcomes and that overall physiological health matters more.

Dr. Sun and team say there is still much to learn, and that more research will be vital for improving patient outcomes with regard to frailty in years to come.

“Frailty should be incorporated into preoperative risk stratification models to assist with optimal selection of operative candidates. Effective preoperative optimization programs such as cardiac prehabilitation, nutritional augmentation and psychosocial support may improve outcomes especially in younger patients,” she says.

Dr. Sun and her team wish to acknowledge and honour the memory of Dr. Jack Tu who passed away during the preparation of this manuscript for publication.

Source:

https://www.ottawaheart.ca/the-beat/2018/07/20/frailty-may-be-more-deadly-younger-heart-patients-study-finds

Tagged with:

About author

Related Articles