Related Experiment Video
Updated: Sep 26, 2025
Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles
Published on: July 26, 2024
A Heart Team Approach to Assessing Frailty in the Cardiac Catheterization Laboratory
Ryan A T Bricknell1, Logan S Schwarzman1, Jeffrey Taylor1
1Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States of America.
Insights
Frailty assessments help the Heart Team make safer decisions for patients undergoing coronary interventions. Using the Risk Analysis Index Questionnaire (RAI-C) effectively identified frailer patients and guided them toward less invasive treatments.
Area of Science:
- Cardiology
- Gerontology
- Health Services Research
Background:
- Frailty is a significant predictor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI).
- Current understanding of how patient frailty influences cardiac patient management and intervention decisions is limited.
- This study investigated the alignment between clinical decisions and quantified frailty status in cardiac patients.
Purpose of the Study:
- To determine if Heart Team decisions on coronary interventions (medical management, PCI, CABG) align with patient frailty.
- To assess the effectiveness of the Risk Analysis Index Questionnaire (RAI-C) in measuring frailty in this population.
- To evaluate the impact of frailty on the choice of intervention, including reduced invasiveness.
Main Methods:
- A cross-sectional quality-improvement study was conducted at a Veterans Affairs hospital.
- Nurses administered the RAI-C frailty assessment to patients before coronary angiography.
- Interventional cardiologists remained blinded to RAI-C results during initial decision-making.
Main Results:
- Frailty was positively associated with receiving reduced invasiveness interventions (RI) and medical management (MM).
- Higher frailty scores were negatively associated with undergoing PCI.
- No significant association was found between frailty and undergoing coronary artery bypass grafting (CABG).
Conclusions:
- The Heart Team's decisions at baseline tended to reduce high-risk interventions for frailer patients.
- A Heart Team model incorporating the RAI-C is effective for frailty assessment in cardiac patients.
- The RAI-C is recommended for clinical use to guide shared decision-making in coronary intervention management.
Introduction:
Frailty is a well-documented risk factor for increased morbidity and mortality among patients undergoing percutaneous coronary intervention (PCI). There remains a lack of knowledge regarding the impact of patient frailty in cardiac patient management and outcomes. Thus, this study examined whether the Heart Team, without using frailty assessments, made decisions regarding coronary interventions [medical management (MM) vs. PCI vs. coronary artery bypass grafting (CABG)] that aligned with formally quantified frailty status.
Material And Methods:
This cross-sectional quality-improvement (QI) study was performed at a single, large, urban Veterans Affairs Hospital. From September 2019 to November 2020, heart team nurses approached patients prior to coronary angiograms and assessed for frailty using the Risk Analysis Index Questionnaire (RAIC). Interventional cardiologists were blinded to the results. This study's independent variable was RAI-C score. The outcome variables were "intervention performed" (MM, PCI, or CABG) and presence of a "reduced invasiveness intervention" (RI).
Results:
Ninety-five of the 182 participants had obstructive coronary artery disease. Among them, there were 69 PCIs, 10 CABGs, and 16 MMs. 26 received RIs. The primary outcomes demonstrated that frailty score was positively associated with receiving RI [adjusted OR = 1.13, 95% CI = 1.02-1.24, p = 0.02] and MM [adjusted OR = 1.13, CI = 1.02-1.25, p = 0.02], and negatively associated with receiving PCI [adjusted OR = 0.94, CI = 0.88-0.998, p = 0.04]. There was no significant association between frailty and the likelihood of undergoing CABG [AOR = 0.95, CI = 0.81-1.10, p = 0.47].
Conclusion:
This study demonstrated that the Heart Team and patients at baseline reduced high-risk interventions in frailer patients. A Heart Team, shared-decision-making model utilizing the RAI-C was found to be efficient and effective at measuring frailty in coronary angiogram patients and should be considered for use in the clinical setting.
More Related Videos
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:26Cardiac Catheterization IV: Nursing Management
01:24Cardiac Catheterization III: Left Heart Catheterization
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:21Cardiac Catheterization II: Right Heart Catheterization