Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States of America.
Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United States of America.
Cardiovasc Revasc Med. 2022 Oct;43:38-42. doi: 10.1016/j.carrev.2022.04.001. Epub 2022 Apr 9.
Frailty is a well-documented risk factor for increased morbidity and mortality among patients undergoing percutaneous coronary intervention (PCI). There remains a lack of knowledge regarding the impact of patient frailty in cardiac patient management and outcomes. Thus, this study examined whether the Heart Team, without using frailty assessments, made decisions regarding coronary interventions [medical management (MM) vs. PCI vs. coronary artery bypass grafting (CABG)] that aligned with formally quantified frailty status.
This cross-sectional quality-improvement (QI) study was performed at a single, large, urban Veterans Affairs Hospital. From September 2019 to November 2020, heart team nurses approached patients prior to coronary angiograms and assessed for frailty using the Risk Analysis Index Questionnaire (RAIC). Interventional cardiologists were blinded to the results. This study's independent variable was RAI-C score. The outcome variables were "intervention performed" (MM, PCI, or CABG) and presence of a "reduced invasiveness intervention" (RI).
Ninety-five of the 182 participants had obstructive coronary artery disease. Among them, there were 69 PCIs, 10 CABGs, and 16 MMs. 26 received RIs. The primary outcomes demonstrated that frailty score was positively associated with receiving RI [adjusted OR = 1.13, 95% CI = 1.02-1.24, p = 0.02] and MM [adjusted OR = 1.13, CI = 1.02-1.25, p = 0.02], and negatively associated with receiving PCI [adjusted OR = 0.94, CI = 0.88-0.998, p = 0.04]. There was no significant association between frailty and the likelihood of undergoing CABG [AOR = 0.95, CI = 0.81-1.10, p = 0.47].
This study demonstrated that the Heart Team and patients at baseline reduced high-risk interventions in frailer patients. A Heart Team, shared-decision-making model utilizing the RAI-C was found to be efficient and effective at measuring frailty in coronary angiogram patients and should be considered for use in the clinical setting.
虚弱是接受经皮冠状动脉介入治疗（PCI）的患者发病率和死亡率增加的一个有据可查的危险因素。关于患者虚弱对心脏患者管理和结局的影响，我们仍然知之甚少。因此，本研究检查了心脏团队在没有使用虚弱评估的情况下，是否根据正式量化的虚弱状况做出了关于冠状动脉介入治疗的决策[药物治疗（MM）与 PCI 与冠状动脉旁路移植术（CABG）]。
这是一项在一家大型城市退伍军人事务医院进行的横断面质量改进（QI）研究。从 2019 年 9 月至 2020 年 11 月，心脏团队护士在冠状动脉造影前接触患者，并使用风险分析指数问卷（RAIC）评估虚弱程度。介入心脏病专家对结果不知情。本研究的自变量是 RAI-C 评分。因变量是“进行的干预”（MM、PCI 或 CABG）和存在“降低侵入性干预”（RI）。
182 名参与者中有 95 名患有阻塞性冠状动脉疾病。其中 69 人接受了 PCI，10 人接受了 CABG，16 人接受了 MM。26 人接受了 RI。主要结果表明，虚弱评分与接受 RI 呈正相关[调整后的 OR = 1.13，95%CI = 1.02-1.24，p = 0.02]和 MM [调整后的 OR = 1.13，CI = 1.02-1.25，p = 0.02]，与接受 PCI 呈负相关[调整后的 OR = 0.94，CI = 0.88-0.998，p = 0.04]。虚弱与接受 CABG 的可能性之间没有显著关联[AOR = 0.95，CI = 0.81-1.10，p = 0.47]。
本研究表明，心脏团队和患者在基线时减少了虚弱患者的高危干预措施。发现心脏团队使用 RAI-C 的共同决策模型在测量冠状动脉造影患者的虚弱程度方面是有效和有效的，应考虑在临床环境中使用。
