Key result
Higher Essential Frailty Toolset score linked to ~28% higher mortality per point after CABG.
Why the study?
The Essential Frailty Toolset is easy to use and predictive of adverse events after aortic valve replacement, but its performance in patients undergoing coronary artery bypass grafting needed evaluation.
Does preoperative frailty assessed by the Essential Frailty Toolset predict long-term all-cause mortality and postoperative adverse events in older adults undergoing isolated coronary artery bypass grafting?
Cohort (n=500)
Yes
Does preoperative frailty assessed by the Essential Frailty Toolset predict long-term all-cause mortality and postoperative adverse events in older adults undergoing isolated coronary artery bypass grafting?
The Essential Frailty Toolset (EFT) is a rapid, pragmatic point-of-care frailty assessment that independently predicts long-term mortality, prolonged hospitalization, institutional discharge, readmission, and 1-year disability in older adults undergoing isolated CABG, adding incremental prognostic discrimination beyond the STS-PROM score.
Answers are grounded in this paper and cite their sources.
May enhance preoperative risk assessment in older CABG patients; extends EFT prognostic data but remains hypothesis-generating for practice change.
Background The Essential Frailty Toolset (EFT) was shown to be easy to use and predictive of adverse events in patients undergoing aortic valve replacement procedures. The objective of this study was to evaluate the EFT in patients undergoing coronary artery bypass grafting procedures. Methods and Results The McGill Frailty Registry prospectively included patients ≥60 years of age undergoing urgent or elective isolated coronary artery bypass grafting between 2011 and 2018 at 2 hospitals. The preoperative EFT was scored 0 to 5 points as a function of timed chair rises, Mini‐Mental Status Examination, serum albumin, and hemoglobin. The primary outcome was all‐cause mortality assessed by Cox proportional hazards regression. The cohort consisted of 500 patients with a mean age of 71.4 ± 6.4 years, of which 27% presented with acute coronary syndromes requiring urgent surgery. The mean EFT was 1.3 ± 1.1 points, 132 (26%) were nonfrail, 298 (60%) were prefrail, and 70 (14%) were frail. Over a median follow‐up of 4.0 years, 78 deaths were observed. In nonfrail, prefrail, and frail patients, survival at 1 year was 98%, 95%, and 91%, and at 5 years was 89%, 83%, and 63% ( P <0.001). After adjustment, each incremental EFT point was associated with a hazard ratio of 1.28 (95% CI, 1.05–1.56) and frail patients had a 3‐fold increase in all‐cause mortality. Conclusions The EFT is a pragmatic and highly prognostic tool to assess frailty and guide decisions for coronary artery bypass grafting in older adults. Furthermore, the EFT may be actionable through targeted interventions such as cardiac rehabilitation and nutritional optimization.
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Solomon et al. (2021) conducted a cohort in Severe coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) (n=500). Preoperative frailty assessed by the Essential Frailty Toolset (EFT, scored 0-5 points) vs. Nonfrail/robust status (EFT score of 0) or lower EFT score was evaluated on All-cause mortality over a median follow-up of 4.0 years (per incremental EFT point) (HR 1.28, 95% CI 1.05-1.56, p=<0.001). Each incremental point on the Essential Frailty Toolset was associated with higher all-cause mortality in older adults undergoing isolated CABG.
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