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Long SO, Hope SV. What patient-reported outcome measures may be suitable for research involving older adults with frailty? A scoping review. Eur Geriatr Med 2024:10.1007/s41999-024-00964-5. [PMID: 38532081 DOI: 10.1007/s41999-024-00964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The need to develop and evaluate frailty-related interventions is increasingly important, and inclusion of patient-reported outcomes is vital. Patient-reported outcomes can be defined as measures of health, quality of life or functional status reported directly by patients with no clinician interpretation. Numerous validated questionnaires can thus be considered patient-reported outcome measures (PROMs). This review aimed to identify existing PROMs currently used in quantitative research that may be suitable for older people with frailty. METHOD PubMed and Cochrane were searched up to 24/11/22. Inclusion criteria were quantitative studies, use of a PROM, and either measurement of frailty or inclusion of older adult participants. Criteria were created to distinguish PROMs from questionnaire-based clinical assessments. 197 papers were screened. PROMs were categorized according to the domain assessed, as derived from a published consensus 'Standard Set of Health Outcome Measures for Older People'. RESULTS 88 studies were included. 112 unique PROMs were used 289 times, most frequently the SF-36 (n = 21), EQ-5D (n = 21) and Barthel Index (n = 14). The most frequently assessed outcome domains included Mood and Emotional Health and Activities of Daily Living, with fewer assessments of Participation in Decision-Making and Carer Burden. CONCLUSIONS PROM usage in frailty research is highly heterogeneous. Frequently used PROMs omit important outcomes identified by older adults. Further research should evaluate the importance of specific outcomes and identify PROMs relevant to people at different stages of frailty. Consistent and appropriate PROM use in frailty research would facilitate more effective comparisons and meaningful evaluation of frailty interventions.
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Affiliation(s)
- S O Long
- University of Exeter, Exeter, UK
| | - S V Hope
- University of Exeter, Exeter, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
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Wong CWY, Yu DSF, Li PWC, Chan BS. The prognostic impacts of frailty on clinical and patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures: A systematic review and meta-analysis. Ageing Res Rev 2023; 85:101850. [PMID: 36640867 DOI: 10.1016/j.arr.2023.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Frailty is emerging as an important prognostic indicator for patients undergoing cardiac surgeries/procedures. We sought to evaluate the prognostic and differential impacts of frailty on patients undergoing coronary artery or valvular surgical procedures of different levels of invasiveness, and to explore the differential predictability of various frailty measurement models. METHODS Eight databases were searched for prospective cohort studies that have adopted validated measure(s) of frailty and reported clinical, healthcare service utilization, or patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures. RESULTS Sixty-two articles were included (N = 16,679). Frailty significantly predicted mortality (short-term [≤ 30 days]: odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.28-4.26; midterm [6 months to 1 year]: OR: 3.93, 95%CI: 2.65-5.83; long-term [>1 year]: HR: 2.23, 95%CI: 1.60-3.11), postoperative complications (ORs: 2.54-3.57), discharge to care facilities (OR: 5.52, 95%CI: 3.84-7.94), hospital readmission (OR: 2.00, 95%CI: 1.15-3.50), and reduced health-related quality of life (HRQoL; standardized mean difference: -0.74, 95%CI: -1.30 to -0.18). Subgroup analyses showed that frailty exerted a greater impact on short-term mortality in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional and physical-aspect-focused frailty measurements performed equally in predicting mortality, but multidimensional measurements were more predictive of hospital readmission than physical-aspect-focused measurements. CONCLUSION Frailty was predictive of postoperative mortality, complications, increased healthcare service utilization, and reduced HRQoL. The impact of frailty on short-term mortality was more prominent in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional measures of frailty enhanced prognostic risk estimation, especially for hospital readmission.
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Affiliation(s)
- Cathy W Y Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 543, 5/Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong.
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 521, 5/Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong.
| | - Polly W C Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 523, 5/F Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong.
| | - Bernice Shinyi Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 543, 5/Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong.
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Saeed S, Skaar E, Romarheim A, Chambers JB, Bleie Ø. Shared Decision-Making and Patient-Reported Outcome Measures in Valvular Heart Disease. Front Cardiovasc Med 2022; 9:863040. [PMID: 35463777 PMCID: PMC9024058 DOI: 10.3389/fcvm.2022.863040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
Patient-centered health care emphasizes shared decision-making (SDM), incorporating both clinical evidence and patient preferences and values. SDM is important in heart valve disease, both because there might be more than one treatment option and due to the importance of adherence after intervention. We aimed to describe patient information and involvement in decision-making about care and recording of patient-reported outcome measures (PROMs) in valve interventions. The opinion piece and recommendations are based upon literature review and our own experience from specialist valve clinics. Before a valve intervention, adequate patient information, discussion of the various treatment options and exploring patient preferences, in line with the concept of SDM, may improve post-intervention quality of life. After intervention, patients with prosthetic heart valves require adequate counseling and close follow-up to make them more confident and competent to manage their own health, as well as to maintain the efficacy of treatment provided. PROMs inform SDM before and improve care after valve intervention, focusing on outcomes beyond mortality and morbidity. SDM may improve post-intervention quality of life. Formal PROMs questionnaires inform SDM, quantify patient centered changes and should be used more often in clinical practice and research. A thorough assessment of baseline frailty status in patients scheduled for valve intervention is essential and may affect postoperative outcome.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- *Correspondence: Sahrai Saeed
| | - Elisabeth Skaar
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Andrea Romarheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - John B. Chambers
- Cardiothoracic Centre, Guy's and Saint Thomas' Hospital, London, United Kingdom
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Lauck SB, McCalmont G, Smith A, Højberg Kirk B, de Ronde-Tillmans M, Wundram S, Adhami N. Setting a Benchmark for Quality of Care. Crit Care Nurs Clin North Am 2022; 34:215-231. [DOI: 10.1016/j.cnc.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Perrotti A, Francica A, Monaco F, Quintana E, Sponga S, El-Dean Z, Salizzoni S, Loizzo T, Salsano A, Di Cesare A, Benassi F, Castella M, Rinaldi M, Chocron S, Vendramin I, Faggian G, Santini F, Nicolini F, Milano AD, Ruggieri VG, Onorati F. Post-operative Quality of Life after Full-sternotomy and Mini-sternotomy Aortic Valve Replacement. Ann Thorac Surg 2021; 115:1189-1196. [PMID: 34971595 DOI: 10.1016/j.athoracsur.2021.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/16/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few longitudinal data exist comparing quality of life (QoL) after full sternotomy aortic valve replacement (fsAVR) vs mini-sternotomy AVR (msAVR) METHODS: 1844 consecutive AVR prospectively enrolled in a European multicentre Registry were dichotomized according to surgical access. A non-parsimonious propensity-score matching selected 187 pairs of fsAVR or msAVR with comparable baseline characteristics. Hospital outcome was compared in the two groups. QoL was assessed with Short Form-36, further detailed in its Physical Component Score (PCS) and Mental Component Score (MCS). QoL was investigated at hospital admission, discharge, 1 month, 6 months and 1 year thereafter. RESULTS There were 1654 fsAVR and 190 msAVR in the entire population. fsAVR showed a worse preoperative risk-profile, a longer ICU length of stay (59.7 hours vs 38.8, p=0.002), and a higher life-threatening/disabling bleeding (4.1% vs. 0%; p=0.011); msAVR reported a higher early reintervention for failed index intervention (2.1% vs. 0.5%, p=0.001). QoL showed better PCS and MCS at 1 month after fsAVR, but no temporal-trend differences (PCS group-time p=0.202; MCS group-time p=0.141). Propensity-matched pairs showed comparable baseline characteristics and hospital outcome (p=NS for all endpoints), and comparable improvements of PCS and MCS over time, but no between-group differences over time (PCS group-time p=0.834; MCS group-time p=0.737). CONCLUSIONS Patients with similar baseline profiles report comparable hospital outcome and comparable improvement of physical and mental health, up to 1 year after surgery, with both fsAVR and msAVR. As for QoL, mini-sternotomy does not seem to offer any advantage compared to the traditional approach.
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Affiliation(s)
- Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Francesco Monaco
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Edward Quintana
- Division of Cardiac Surgery, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Sandro Sponga
- Division of Cardiac Surgery, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Stefano Salizzoni
- Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy
| | - Tommaso Loizzo
- Cardiac Surgery Unit, Department of Emergency and Organ Transplants, Bari, Italy
| | - Antonio Salsano
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Alessandro Di Cesare
- Cardiovascular and Thoracic Surgery Unit, Robert Debre University Hospital, Reims, France; Université de Reims Champagne-Ardennes, Reims, France
| | - Filippo Benassi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Manuel Castella
- Division of Cardiac Surgery, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy
| | - Sidney Chocron
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Igor Vendramin
- Division of Cardiac Surgery, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | | | - Aldo Domenico Milano
- Cardiac Surgery Unit, Department of Emergency and Organ Transplants, Bari, Italy
| | - Vito Giovanni Ruggieri
- Cardiovascular and Thoracic Surgery Unit, Robert Debre University Hospital, Reims, France; Université de Reims Champagne-Ardennes, Reims, France
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
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McDonagh J, Prichard R, Macdonald PS. Frailty: A Dynamic Process in Aortic Stenosis? Heart Lung Circ 2021; 30:1110-1111. [PMID: 34052131 DOI: 10.1016/j.hlc.2021.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Julee McDonagh
- College of Health, Medicine and Wellbeing/School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia.
| | - Roslyn Prichard
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Qld, Australia
| | - Peter S Macdonald
- St Vincent's Hospital Heart and Lung Clinic, St Vincent's Hospital Sydney, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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