Frailty Status and Preoperative Cardiac Risk Stratification in Older Adults Undergoing Noncardiac Surgery: A...

Area of Science:

• Geriatric Medicine
• Cardiology
• Surgical Risk Assessment

Background:

• Frailty is common in older adults and linked to poor surgical outcomes.
• Current guidelines suggest using frailty for preoperative cardiac risk stratification.
• The added prognostic benefit of frailty assessment beyond existing tools is unclear.

Purpose of the Study:

• To determine the incremental prognostic value of frailty in predicting major adverse cardiac events (MACE) after major noncardiac surgery.
• To assess if frailty provides additional predictive information beyond established risk factors, functional capacity, and biomarkers.

Main Methods:

• Secondary analysis of a prospective cohort study of patients aged 65+ undergoing elective noncardiac surgery.
• Frailty assessed using the Clinical Frailty Scale (CFS); MACE defined as myocardial infarction, cardiac arrest, or death within 30 days.
• Multivariable logistic regression and methods assessing incremental predictive value were used, adjusting for clinical indices, functional status (Duke Activity Status Index), and natriuretic peptides.

Main Results:

• Of 1939 participants, 43% were frail (CFS ≥4); 4.9% experienced MACE.
• Frailty (CFS ≥4) was associated with MACE after adjusting for clinical factors (OR 1.62), but this association attenuated when functional capacity or biomarkers were included.
• Frailty improved prediction beyond clinical factors alone, but not when functional capacity or biomarkers were added.

Conclusions:

• Frailty is associated with increased cardiac risk in older surgical patients.
• Frailty offers incremental prognostic value beyond basic clinical factors.
• The utility of frailty assessment diminishes when functional capacity or biomarkers are available, suggesting selective use.