Anesthesia Geriatric Evaluation and Quality of Life After Cardiac Surgery (AGE)

Anesthesia Geriatric Evaluation and the Prediction of Quality of Life in Elderly Cardiac Surgery Patients

A prospective observational cohort study to assess the predictive value of preoperative frailty on postoperative quality of life in cardiac surgery patients.

Study Overview

• Status: Completed
• Conditions: Quality of Life

Detailed Description

Introduction:

The current population is ageing in a rapid pace. Currently elderly represent 17.8% of the Dutch population. Most recent estimates show this will increase to 25.6% 20 years' time. This rise in elderly will also reflect on the population of patients being referred for cardiac surgery. Especially elderly patients are at risk for postoperative complications, mortality or functional decline. In frail elderly this effect might be more pronounced. Frailty is an umbrella term that encompasses patient related factors such as weight loss, muscle wasting, inactivity, comorbidities and polypharmacy. Current scoring systems that are used to predict postoperative mortality and complications following cardiac surgery perform poorly in the elderly population and do not take into account frailty. Moreover they are designed to predict mortality and complications and are not validated to predict patient reported outcome measures such as quality of life or functional status. The aim of the AGE study is assess the value of frailty factors in predicting an improvement in quality of life one year after cardiac surgery.

Methods:

The AGE study is a prospective observational cohort study. All patients aged 70 years or older, scheduled for cardiac surgery, mentally competent and have signed informed consent are eligible for the study. During routine preoperative screening patients will be screened for frailty using different questionnaires and physical tests. The battery of tests exist of Short Form 36 (SF36), Multi Nutritional Assessment (MNA), Mini Mental State Examination (MMSE) and Nagi's scale for disability, Three physical tests: five meter walking speed, timed get up and go test and hand grip strength. A non-invasive measurement of Advanced Glycation Endproducts (AGEs) and a medication review. A blood sample will be taken to determine vitamin status, iron deficiency, pre-operative inflammatory parameters, CMV status, pneumococcal carriage and cardiac biomarkers. After surgery electronic patients charts will be studied to score postoperative complications or mortality. Three months and one year after cardiac surgery patients will receive SF-36 and World Health Organization Disability Assessment Schedule (WHODAS) 2.0 questionnaires to determine quality of life and functional status.

• Study Type: Observational
• Enrollment (Actual): 577

Contacts and Locations

Study Locations

• Netherlands
  • Utrecht
    • Nieuwegein, Utrecht, Netherlands, 3435 CM
      • St Antonius hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 70 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All patients planned for elective cardiac surgery and aged 70 years or older.

Description

Inclusion Criteria:

• Aged 70 years or older
• Mentally competent
• Planned cardiac surgery (coronary, valvular, rhythm, aortic or combination of those)
• Signed informed consent

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Life Assessed by Short Form-36 (SF-36)	Assessed by Short Form-36 (SF-36)	12 months after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Life Assessed by Short Form-36 (SF-36)	Assessed by Short Form-36 (SF-36)	3 months after surgery
Psychosocial or physical functioning Assessed by World Health Organisation Disability Assessment Schedule 2.0	Assessed by World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0)	3 and 12 months after surgery
Incidence of postoperative complications	Postoperative complications are scored according to Dutch national guidelines on reporting complications in cardiac surgery and include rethoracotomy, reoperation, bleeding, arrythmia, stroke, myocardial infarction, deep sternal wound infection, pneumonia, urinary tract infection, sepsis, respiratory insufficiency, prolonged respiratory support and renal failure (AKI).	30 days after surgery
Mortality		30 days and 12 months after surgery
Length of stay in hospital and ICU		Post-Surgery. The expected length of stay in the ICU is 1 to 5 days and in hospital 5 to 10 days.
Postoperative delirium	Delirium according to intensive care delirium screening (ICDSC) or delirium observation screening (DOS)	30 days

Collaborators and Investigators

• Sponsor: St. Antonius Hospital
• Investigators: Principal Investigator: Peter G Noordzij, MD, PhD, St. Antonius Hospital

Publications and helpful links

General Publications

• Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, Morin JF, Langlois Y, Ohayon SM, Monette J, Boivin JF, Shahian DM, Bergman H. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes. 2012 Mar 1;5(2):222-8. doi: 10.1161/CIRCOUTCOMES.111.963157. Epub 2012 Mar 6.
• Fruitman DS, MacDougall CE, Ross DB. Cardiac surgery in octogenarians: can elderly patients benefit? Quality of life after cardiac surgery. Ann Thorac Surg. 1999 Dec;68(6):2129-35. doi: 10.1016/s0003-4975(99)00818-8.
• Chaturvedi RK, Blaise M, Verdon J, Iqbal S, Ergina P, Cecere R, deVarennes B, Lachapelle K. Cardiac surgery in octogenarians: long-term survival, functional status, living arrangements, and leisure activities. Ann Thorac Surg. 2010 Mar;89(3):805-10. doi: 10.1016/j.athoracsur.2009.12.002.
• Ettema RG, Peelen LM, Kalkman CJ, Nierich AP, Moons KG, Schuurmans MJ. Predicting prolonged intensive care unit stays in older cardiac surgery patients: a validation study. Intensive Care Med. 2011 Sep;37(9):1480-7. doi: 10.1007/s00134-011-2314-1. Epub 2011 Jul 30.
• Arends BC, Timmerman L, Vernooij LM, Verwijmeren L, Biesma DH, van Dongen EPA, Noordzij PG, van Oud-Alblas HJB. Preoperative frailty and chronic pain after cardiac surgery: a prospective observational study. BMC Anesthesiol. 2022 Jul 1;22(1):201. doi: 10.1186/s12871-022-01746-x.
• Verwijmeren L, Bosma M, Vernooij LM, Linde EM, Dijkstra IM, Daeter EJ, Van Dongen EPA, Van Klei WA, Noordzij PG. Associations Between Preoperative Biomarkers and Cardiac Surgery-Associated Acute Kidney Injury in Elderly Patients: A Cohort Study. Anesth Analg. 2021 Sep 1;133(3):570-577. doi: 10.1213/ANE.0000000000005650.
• Verwijmeren L, Peelen LM, van Klei WA, Daeter EJ, van Dongen EPA, Noordzij PG. Anaesthesia geriatric evaluation to guide patient selection for preoperative multidisciplinary team care in cardiac surgery. Br J Anaesth. 2020 Feb 14:S0007-0912(20)30014-3. doi: 10.1016/j.bja.2019.12.042. Online ahead of print.

Study record dates

Study Major Dates

• Study Start: July 1, 2015
• Primary Completion (Actual): December 1, 2017
• Study Completion (Actual): December 1, 2017

Study Registration Dates

• First Submitted: August 24, 2015
• First Submitted That Met QC Criteria: August 26, 2015
• First Posted (Estimate): August 31, 2015

Study Record Updates

• Last Update Posted (Actual): March 6, 2018
• Last Update Submitted That Met QC Criteria: March 4, 2018
• Last Verified: March 1, 2018

More Information

Terms related to this study

• Keywords: Quality of Life; Risk Assessment; Frail Elderly; Cardiac Surgical Procedure
• Other Study ID Numbers: NL53243.100.15