Mortality from all-cause and cause-specific in the elderly: Joint implications of anemia and frailty

Association between comprehensive geriatric assessment and Days Alive and Out of Hospital at 30 Days After Cardiac Surgery in Older Patients

OBJECTIVES

To investigate the association of comprehensive geriatric assessment (related to diverse aspects of frailty) with postoperative recovery as measured by days alive and out of the hospital at 30 days (DAOH30) in older patients undergoing cardiac surgery.

DESIGN

Retrospective observational study using data retrieved from a prospective registry.

SETTING

Single tertiary hospital in South Korea.

PARTICIPANTS

A total of 437 patients aged ≥65 years who underwent cardiac surgery between March 2021 and October 2022 were included.

MEASUREMENTS

Comprehensive geriatric assessment included subjective evaluations of functional frailty (cognitive, emotional, and physical aspects) and objective measurements of malnutrition and anaemia. DAOH30 was analysed using multivariable quantile regression to evaluate its association with these three domains.

RESULTS

In the entire cohort (median age 72 years; median DAOH30, 19 days), 85.1% of participants had functional frailty, 9.8% had malnutrition, and 45.8% had anaemia. Older age, cognitive dysfunction, emotional dysregulation, physical decline, malnutrition, and anaemia were associated with shorter DAOH30 (all p < 0.05). In multivariable analysis, malnutrition had the strongest impact, reducing DAOH30 by 6.0 days (95% confidence interval [CI]: -11.103 to -0.263), followed by anaemia (1.2 days, 95% CI: -2.199 to -0.148) and functional frailty (1.0 days, 95% CI: -1.677 to -0.171). Individual components of functional frailty did not retain an independently significant relationship with DAOH30 after adjustment for confounders.

CONCLUSION

Comprehensive geriatric assessment, incorporating functional frailty, malnutrition, and anaemia, demonstrated a significant association with DAOH30 in older patients undergoing cardiac surgery. Among the assessed aspects, malnutrition showed the strongest association, which may underscore the importance of targeted nutritional interventions to improve outcomes in this patient population.

Characteristics of longitudinal changes in quality of life and associated factors in patients post cardiac and thoracic aortic surgery: insights from a prospective cohort study

BACKGROUND

Although quality of life (QOL) is an outcome of postoperative cardiac rehabilitation (CR), its course and related factors from postoperative hospitalization to the post-discharge period have not been adequately investigated. Additionally, the EuroQol-5Dimension-5Level (EQ-5D-5L) index score has not been characterized over the same period. We aimed to characterize QOL changes assessed by the EQ-5D-5L, over the period from hospitalization to 1 year post-discharge, in patients post-cardiac and thoracic aortic surgery, and investigate the factors associated with these temporal changes.

METHODOLOGY

This prospective, single-center study included 117 patients who underwent open cardiovascular surgery (median age, 72 years; men, 69%). Patients were assessed for QOL status when transferred to the general ward; at discharge; and at 6 and 12 months after discharge, using the EQ-5D-5L index score and a generalized linear mixed model with random intercepts. Patients were classified into two groups based on score changes post-discharge. Logistic regression analysis evaluated factors associated with QOL decrease post-discharge.

RESULTS

The EQ-5D-5L index score significantly increased over time, except between 6 and 12 months post-discharge; "Common activities" was the most common dimension showing score improvement. In 25 patients (21%), the EQ-5D-5L index scores were lower after discharge compared to their scores at discharge. In the logistic regression analysis, Barthel Index pre-admission, preoperative hemoglobin level, and Mini-Mental State Examination-Japanese scores pre-discharge were significantly associated with QOL decline after adjusting for the European System for Cardiac Operative Risk Evaluation II score.

CONCLUSIONS

Most patients post-cardiac or thoracic aortic surgery experienced improved QOL from postoperative hospital stay to 1 year post-discharge. However, in patients with pre-operative basic activities of daily living, hemoglobin and post-operative cognitive decline may require ongoing comprehensive CR because of reduced QOL. Given the potential selection bias introduced by the relatively small sample size in this study, future research involving larger populations is necessary.

Association of anemia with all-cause mortality in Chinese centenarians: a prospective cohort study

OBJECTIVES

This study aimed to examine the relationship between anemia and all-cause mortality in Chinese centenarians.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

We included 1002 Chinese centenarians from the China Hainan Centenarian Cohort Study (CHCCS) MEASUREMENTS: Standard procedures were followed to perform blood analysis, home interviews, and physical examinations. Anemia was defined as a hemoglobin level of less than 130 g/L for men and less than 120 g/L for women.

RESULTS

During the 9-year follow-up period, a total of 929 (92.7%) deaths were identified. Cox proportional hazards regression models revealed that anemia (hazard ratio [HR] 1.289, 95% confidence interval [CI]: 1.117-1.489) was significantly associated with all-cause mortality. There was an apparent dose-response relationship between anemia and all-cause mortality. Centenarians with severe anemia had approximately 1.6 times higher likelihood of all-cause mortality than those without anemia (HR 1.662; 95% CI: 1.154-2.394).

CONCLUSION

Anemia is associated with an increased risk of all-cause mortality in Chinese centenarians. Further research will be needed to collect more comprehensive data on the etiology of anemia and causes of death in centenarians.

The Dual Burden of Frailty and Heart Failure

Frailty is highly prevalent among patients with heart failure (HF) and independently predicts adverse outcomes. However, optimal frailty definitions, assessments, and management in HF remain unclear. Frailty is common in HF, affecting up to 80% of patients depending on population characteristics. Even pre-frailty doubles mortality risk versus robust patients. Frailty worsens HF prognosis through systemic inflammation, neurohormonal changes, sarcopenia, and micronutrient deficiency. Simple screening tools like gait speed and grip strength predict outcomes but lack HF-specificity. Comprehensive geriatric assessment is ideal but not always feasible. Exercise, nutrition, poly-pharmacy management, and multidisciplinary care models can help stablize frailty components and improve patient-centred outcomes. Frailty frequently coexists with and exacerbates HF. Routine frailty screening should guide supportive interventions to optimize physical, cognitive, and psychosocial health. Further research on HF-specific frailty assessment tools and interventions is warranted to reduce this dual burden.