Association between frailty and self-reported health following heart valve surgery

Britt Borregaard; Jordi S Dahl; Sandra B Lauck; Jesper Ryg; Selina K Berg; Ola Ekholm; Jeroen M Hendriks; Lars P S Riber; Tone M Norekvål; Jacob E Møller

doi:10.1016/j.ijcha.2020.100671

Association between frailty and self-reported health following heart valve surgery

Int J Cardiol Heart Vasc. 2020 Nov 13:31:100671. doi: 10.1016/j.ijcha.2020.100671. eCollection 2020 Dec.

Authors

Britt Borregaard^{1

2

3}, Jordi S Dahl^{1

3}, Sandra B Lauck^{4

5}, Jesper Ryg^{3

6}, Selina K Berg^{7

8}, Ola Ekholm³, Jeroen M Hendriks^{9

10

11}, Lars P S Riber^{2

3}, Tone M Norekvål^{12

13

14}, Jacob E Møller^{1

3

8}

Affiliations

¹ Department of Cardiology, Odense University Hospital, Denmark.
² Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark.
³ University of Southern Denmark, Denmark.
⁴ Centre for Heart Valve Innovation, St. Paul's Hospital, Canada.
⁵ University of British Columbia, Canada.
⁶ Department of Geriatric Medicine, Odense University Hospital, Denmark.
⁷ Department of Clinical Medicine, University of Copenhagen, Denmark.
⁸ The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark.
⁹ Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, Australia.
¹⁰ College of Nursing and Health Sciences, Flinders University, Australia.
¹¹ Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.
¹² Department of Heart Disease, Haukeland University Hospital, Norway.
¹³ Department of Clinical Science, University of Bergen, Norway.
¹⁴ Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway.

Abstract

Background: Knowledge about the association between frailty and self-reported health among patients undergoing heart valve surgery remains sparse. Thus, the objectives were to I) describe changes in self-reported health at different time points according to frailty status, and to II) investigate the association between frailty status at discharge and poor self-reported health four weeks after discharge among patients undergoing heart valve surgery.

Methods: In a prospective cohort study, consecutive patients undergoing heart valve surgery, including transapical/transaortic valve procedures were included. Frailty was measured using the Fried score, and self-reported health using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL-5 Dimensions 5-Levels Health Status Questionnaire (EQ-5D-5L).To investigate the association between frailty and self-reported health, multivariable logistic regression models were used. Analyses were adjusted for sex, age, surgical risk evaluation (EuroScore) and procedure and presented as odds ratios (OR) with 95% confidence intervals (CI).

Results: Frailty was assessed at discharge in 288 patients (median age 71, 69% men); 51 patients (18%) were frail. In the multivariable analyses, frailty at discharge remained significantly associated with poor self-reported health at four weeks, OR (95% CI): EQ-5D-5L Index 3.38 (1.51-7.52), VAS 2.41 (1.13-5.14), and KCCQ 2.84 (1.35-5.97).

Conclusion: Frailty is present at discharge in 18% of patients undergoing heart valve surgery, and being frail is associated with poor self-reported health at four weeks of follow-up. This supports a clinical need to address the unique risk of frail patients among heart valve teams broadly, and not only to measure frailty as a marker of operative risk.

Keywords: Cardiac surgery; Frailty; Health-related quality of life; Heart valves.