Frailty

In North America, octogenarians are the fastest growing demographic. Chronological age of a patient is not always the same as their biological age, and their biological status can vary from robust to frail.

Frail patients are predisposed to falls, institutionalization, hospitalization and mortality. In the realm of cardiac surgery, there is little research examining frailty as a risk factor for  surgical intervention. We have previously shown that frail patients have much higher mortality rates, and often require prolonged care in-hospital. The impact of minor levels of frailty, such that patients may be considered vulnerable rather than actively frail, remains unexplored. 

Purpose
This study is designed to explore the link between having a lower fitness level before having heart surgery and negative results after surgery. Some of these negative results are longer in-hospital stay and being discharged to a long-term care center. In this study, we will find out patient's fitness level before their surgery, by exploring the relationship between frailty and cardiac surgery outcomes. This will provide us with information to assist us in determining how these patients’ frailty levels affect their recovery. 

Audience
We anticipate about 250-400 people will participate in this study at the Halifax Infirmary in Nova Scotia and the New Brunswick Heart Centre in Saint John, New Brunswick. Only patients over the age of 65, undergoing first time valve, coronary artery bypass graft (CABG), or valve repair or replacement will be considered. 

Our study involves a meeting with the patient before surgery, a phone interview after surgery and a meeting with the patient’s collateral (e.g., spouse, child). Both parties must consent to participate in the research before the study can proceed. Before surgery, they are asked questions so that their frailty level can be determined. They are asked to fill out a quality of life questionnaire and a function questionnaire before their surgery. Five to seven months after surgery, they will again be asked to complete the same quality of life questionnaire and answer a few other relevant questions by phone. 

Implications
Information gained from this study will help us better educate future heart surgery patients about their possible risks. The impact of even minor degrees of frailty is important in determining surgical outcomes and the number of individuals experiencing frailty in this population (65 years of age and older) is higher than previously expected. Findings from this study should be taken into account when patients and practitioners consider cardiac surgical intervention in this age group. Our goal is that patients who know more about their personal risks will be able to make better informed decisions about what treatment options they with to pursue with their doctor.