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- Essai clinique NCT07677319
SAGE-Heart : Senior Assessment fraGility and Post-opErative QALYs 1 Year After Emergency HEART Surgery for Patients Aged 75 and Older (SAGE-Heart)
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
The advancement of structural cardiology, particularly with percutaneous valve interventions, offers new treatment options without the need for cardiopulmonary bypass (CPB). Despite an increase in the use of these techniques, some studies highlight a notable rise in CPB usage in patients aged 80 and over, from 13.8% in 2013 to 20.5% in 2022. In France, the population aged 85 and above is expected to triple by 2050, meaning more elderly patients will be eligible for CPB cardiac surgery. Several global studies have examined the outcomes of older individuals undergoing CPB cardiac surgery. While EuroSCORE II and STS scores are effective in predicting short-term mortality, they lack accuracy in predicting long-term mortality, particularly in frail patients, and do not assess quality of life. New tools to evaluate frailty, such as the Clinical Frailty Scale (CFS), are now used in preoperative assessments for planned cardiac interventions. Identifying frail elderly patients early is crucial for improving patient and family information on care plans, especially in high-risk surgeries. Even in emergencies, patients must remain involved in their health decisions, and multidisciplinary collaboration is vital for improving postoperative recovery and quality of life.
Data will be collected :
- Preoperative: During the anesthesia consultation: Calculation of the CFS (frailty assessment = CFS ≥ 4) EuroQoL 5D-5L (quality of life, with the index calculated with the French value set of the EuroQol), and routine care (renal function: urea, creatinine, albumin levels).
- Postoperative (ICU and hospital): Collection of complication incidence, mortality (all causes and LATA-related).
- Follow-up (by phone at 3, 6, and 12 months): CFS and EuroQoL scores, prevalence of chronic pain and analgesic use, dialysis dependency, accommodation status, readmission rates, and death date if applicable.
Type d'étude
Inscription (Estimé)
Phase
- N'est pas applicable
Contacts et emplacements
Coordonnées de l'étude
- Nom: Simon CARRE, MD
- Numéro de téléphone: +33 0556795679
- E-mail: simon.carre@chu-bordeaux.fr
Lieux d'étude
-
-
France
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Bordeaux, France, France, 33076
- Recrutement
- University Hospital, Bordeaux
-
Contact:
- Simon CARRE, MD
- Numéro de téléphone: +33 0556795679
- E-mail: simon.carre@chu-bordeaux.fr
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte plus âgé
Accepte les volontaires sains
La description
Inclusion Criteria:
Patients aged ≥ 75 years who are affiliated with or beneficiaries of a social security scheme and undergoing emergency cardiac surgery under cardiopulmonary bypass, either immediate or urgent (relative) :
- Immediate emergency surgery: intervention performed before the start of the next working day following the decision to operate,
- Urgent (relative) emergency surgery: patients not admitted electively for surgery but requiring an intervention during the current hospital stay for medical reasons, and who cannot be discharged without undergoing a definitive procedure
Exclusion Criteria:
- Patients requiring preoperative cardiopulmonary resuscitation
- Scheduled (elective) surgery
- Lack of informed consent
- Impaired consciousness at the time of inclusion (defined by a Glasgow Coma Scale score < 15)
- Individuals under legal guardianship or judicial protection
- Individuals participating in another interventional research protocol
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: La prévention
- Répartition: Non randomisé
- Modèle interventionnel: Affectation à un seul groupe
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: Frail group
Patients with Clinical Frailty Score CFS ≥ 4
|
Phone calls will be made at 3, 6, and 12 months to report quality of life scores (EuroQol EQ 5D-5L) and other postoperative data
|
|
Expérimental: Non-frail group
Patients with Clinical Frailty Score CFS < 4
|
Phone calls will be made at 3, 6, and 12 months to report quality of life scores (EuroQol EQ 5D-5L) and other postoperative data
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Quality-Adjusted Life Years (QALYs) according to preoperative frailty status
Délai: Month 12
|
QALYs over the 12-month follow-up will be estimated from EQ-5D-5L utility scores collected at baseline, Month 3, Month 6, and Month 12 together with survival data, and compared between participants with preoperative frailty (Clinical Frailty Scale ≥4) and those without frailty (Clinical Frailty Scale <4), with adjustment for EuroSCORE II.
|
Month 12
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Postoperative complications
Délai: From surgery through,Day 28
|
Incidence of postoperative cardiac, respiratory, renal, infectious, and neurological complications during the first 28 postoperative days.
|
From surgery through,Day 28
|
|
All-cause mortality
Délai: Through Month 12
|
All-cause mortality assessed during ICU stay, hospital stay, and at Month 3, Month 6, and Month 12.
|
Through Month 12
|
|
EQ-5D-5L Utility Index
Délai: Baseline, Month 3, Month 6, and Month 12
|
Health-related quality of life assessed using the EQ-5D-5L utility index derived from the French value set
|
Baseline, Month 3, Month 6, and Month 12
|
|
Dialysis dependence
Délai: Month 3, Month 6, and Month 12
|
Dialysis dependence among participants not receiving chronic dialysis before surgery.
|
Month 3, Month 6, and Month 12
|
|
Length of intensive care unit stay
Délai: From ICU admission to ICU discharge (assessed up to Day 28)
|
Duration of postoperative ICU stay.
|
From ICU admission to ICU discharge (assessed up to Day 28)
|
|
Length of hospital stay
Délai: From surgery to hospital discharge
|
Total postoperative hospital length of stay.
|
From surgery to hospital discharge
|
|
Hospital readmissions
Délai: Month 3, Month 6, and Month 12
|
Number of hospital readmissions since discharge, assessed at each follow-up visit.
|
Month 3, Month 6, and Month 12
|
|
Chronic postoperative pain
Délai: Month 3, Month 6, and Month 12
|
Presence of chronic pain related to cardiac surgery.
|
Month 3, Month 6, and Month 12
|
|
Analgesic consumption
Délai: Month 3, Month 6, and Month 12
|
Type of analgesic medication and frequency of use since the previous follow-up assessment.
|
Month 3, Month 6, and Month 12
|
|
Living situation
Délai: Month 3, Month 6, and Month 12
|
Living at home versus institutionalization during follow-up.
|
Month 3, Month 6, and Month 12
|
|
EQ-5D-5L visual analogue scale (EQ VAS)
Délai: Baseline, Month 3, Month 6, and Month 12
|
Self-rated health status assessed using the EQ-5D-5L visual analogue scale (0-100).
|
Baseline, Month 3, Month 6, and Month 12
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Simon CARRE, MD, University Hospital, Bordeaux
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- CHUBX 2025/040
Plan pour les données individuelles des participants (IPD)
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Informations sur les médicaments et les dispositifs, documents d'étude
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