The prognostic impacts of frailty status on clinical and patient-related outcomes in patients undergoing coronary artery or valvular surgeries/procedures: a systematic review and meta-analysis

Type of funding sources: None.

Frailty is emerging as an important prognostic indicator for patients undergoing cardiac surgeries or procedures.

We sought to evaluate the prognostic and differential impacts of frailty on patients undergoing coronary artery or valvular surgical procedures of different levels of invasiveness, as well as to explore the differential predictability of various frailty measurement models.

Nine databases were searched for prospective cohort studies that have adopted validated measure(s) of frailty and reported clinical, healthcare service utilisation, or patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures. Meta-analysis was conducted using random-effects model.

Sixty-two articles were included (N = 16,679). Frailty significantly predicted mortality (short-term [≤ 30 days]: odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.28–4.26; mid-term [1 year]: OR: 3.93, 95% CI: 2.65–5.83; long-term [>1 year]: HR: 2.23, 95% CI: 1.60–3.11), postoperative complications (ORs: 2.54–3.57), discharge to care facilities (OR: 5.52, 95% CI: 3.84–7.94), hospital readmissions (OR: 2.00, 95% CI: 1.15–3.50), and reduced health-related quality of life (HRQoL; SMD: −0.74, 95% CI: −1.30 to −0.18) (Figure 1 and 2). Subgroup analyses showed that frailty exerted a greater impact on short-term mortality in patients undergoing open-heart surgeries than those receiving transcatheter procedures (Figure 1A), but no significant difference was observed for mid- and long-term mortality between these two groups of patients (Figure 1B and C). Multidimensional and physical-aspect-focused frailty measurements equally predicted mortality and complications, but multidimensional measurements were more predictive of hospital readmissions than physical-aspect-focused measurements (Figure 2B).

Frailty was predictive of postoperative mortality, complications, increased healthcare service utilisation, and reduced HRQoL. The impact of frailty on short-term mortality was more prominent in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional measures of frailty enhanced prognostic risk estimation, especially for hospital readmissions, demonstrating a need to incorporate a formal frailty assessment into routine preoperative risk evaluation to inform therapeutic decision-making.