The European Society of Cardiology (ESC) welcomes the new insight provided by a study into measuring frailty in elderly patients prior to cardiac surgery. In a paper published today in the Journal of the American College of Cardiology (JACC), research is presented that suggests that gait speed in elderly patients – how fast or slowly they walk – can indicate frailty and, therefore, their fitness to undergo cardiac surgery and the likely outcomes that will be achieved. The findings state that slow gait can predict a three-fold increase in the risk of major complications or death from cardiac surgery, and could be used to help cardiologists identify vulnerable patients.
The ESC, however, wishes to emphasise that its recommendations and guidelines regard frailty as a multi-factorial issue and it does not endorse the sole use of a gait speed test. Commenting on the paper, ESC spokesperson Professor Volkmar Falk, Head of Cardiac and Vascular Surgery at the University Hospital in Zurich, says that, “While gait speed is an easy, non-invasive test and is indeed an important component of testing frailty in an elderly patient, it is not always reliable nor is it thorough enough to make decisions on surgical intervention. There are a number of situations in which it cannot be used at all – in patients with mobility problems for instance. We adopt a range of measures to determine the risk factors, including scoring systems that look more widely than a single parameter.”
Also speaking for the ESC, Professor Ottavio Alfieri, Chief of Cardiac Surgery at the San Raffaele University Hospital in Milan, was keen to highlight other methods of assessing frailty. “Nutrition, for example, is a very important factor in determining frailty,” he says. Weight loss and poor appetite are probably better indicators than walking speed and are more reliable too. Using information from multiple sources, which may include walking speed, allows surgeons to predict the most likely outcomes of cardiac surgery and represent a good basis for treatment decisions.”
The study centred on a cohort of 131 patients with an average age of 75. All undertook a gait test, of which 46% were categorised with slow gait stated as an inability to walk five meters in six seconds or less. Gait test measurements were withheld from the patients’ cardiologists so as not to influence treatment decisions. Results indicate that slow walkers faced higher death rates, and took longer to recover and be discharged. They also required more rehab facilities. Elderly women were more likely to be in the slow gait category, especially those with diabetes, and showed an eight-fold increase in risk of mortality and morbidity. Lead author of the study, Doctor Jonathan Afilialo of the SMBD-Jewish General Hospital in Montreal, acknowledged that more research was needed into the gender differences noted.
Professor Falk recently co-authored a research paper on behalf of the European Association of Cardio-Thoracic Surgeons into the assessment of frailty in routine cardiac surgery. This paper advocates a much more comprehensive scoring system than just physical prowess. The European Society of Cardiology wants to reassure patients that walking speed alone is most unlikely to become a pre-determinant for cardiac procedures such as by-pass operations or valve replacement.
Celine Colas - Press Coordinator
European Society of Cardiology
Tel: +33 (0)4 92 94 86 27