Characterisation of frailty phenotypes and analysis of the association with peri-operative/interventional complications in elderly cardiac patients
Authors: Baritello O , Espinosa-Garnica K , Suendermann S , Vogel H , Voeller H , Salzwedel A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Identifying the key frailty phenotypes that impact functional health outcomes in older cardiovascular patients (CVD) in clinical practice is a step towards solving the complex "Rubik's Cube" of frailty. It should be pointed out which frailty phenotypes representing the patient's physical (e.g. mobility, strength, gait speed), cognitive (e.g. dementia) or nutritional status (e.g. risk of malnutrition, protein levels) correlate with major complications (e.g. mortality, delirium) in elderly patients. Phenotypes of frailty that correlate with complications could be used to identify patients at higher risk of poor postoperative outcomes and could be addressed through preventive strategies (e.g. prehabilitation).

Purpose
Identification of physical, nutritional and cognitive frailty phenotypes and investigate the correlation with complications in elderly patients undergoing cardiac surgery (e.g. coronary artery bypass graft, isolated single valve) or transcatheter aortic valve implantation (TAVI).

Methods
Between 06/2021 and 07/2022, patients (77.6 ± 4.3) referred for elective cardiac surgery or TAVI were included in the study. At hospital admission, physical frailty was identified by the simultaneous presence of: low gait speed (5-meter Walk Test), moderate impaired mobility (Timed Up-and-Go), reduced handgrip (dynamometer) and legs strength (5-repetitions chair rise). Mild dementia (Mini-Mental State Examination) characterised cognitive frailty and risk of malnutrition (Mini Nutritional Assessment) plus low serum protein level (serum albumin) nutritional frailty. The primary outcome was the presence of perioperative complications (mortality and major morbidity, e.g. delirium, pneumonia). Additionally, the total number and type of complications and the length of hospital stay (LoS) were collected. Correlations between frailty phenotypes, complications and LoS were calculated (Spearman).

Results
In total, 63 patients were referred to cardiac surgery (n=34, 54%) or TAVI (n=29, 46%) and were included (Table 1). Overall, 20 patients (36%) were characterized as physically frail. 33 patients (52%) were found to be cognitively frail, and 17 patients (26%) identified as nutritionally frail; no significant differences were found between the surgical and TAVI groups (Figure 1). Altogether, 37 patients (59%) experienced ≥ 1 complication such as need of transfusion (n=24, 38%), atrial fibrillation (n=14, 22%), delirium (n=12, 19%), pneumonia (n=8, 13%) or renal failure (n=6, 10%); one patient died. Physical and nutritional frailty correlate with the presence and total number of complications and prolonged LoS, but only in TAVI patients (Figure 1).

Conclusion
If these results are confirmed in a multivariate analysis, preventive strategies targeting physical and nutritional frailty should be considered, especially in TAVI patients, to reduce the incidence of complications and prolonged LoS.