A simplified frailty assessment using three objective measures predicts mid-term outcomes after cardiac surgery

Abstract

Objective: Frailty is a major risk factor for adverse outcomes following cardiac surgery, yet its routine clinical integration is hindered by the lack of a standardized, convenient assessment method. This study aimed to develop and validate a simplified frailty model using three objective measures: gait speed, serum albumin, and grip strength. Methods: In this prospective observational study of 261 patients (≥ 65 years) undergoing elective cardiac surgery, frailty was assessed using both the Japanese Cardiovascular Health Study criteria and our simplified model. The model defined frailty as having ≥ 2 of the following: slowness (gait speed < 1.0 m/s), hypoalbuminemia (albumin ≤ 3.5 g/dL), and weakness (grip strength < 28 kg for men, < 18 kg for women). Results: The simplified model demonstrated high diagnostic accuracy for frailty defined by the Japanese Cardiovascular Health Study criteria (area under the curve = 0.868; sensitivity, 55.8%; specificity, 91.4%). Frailty defined by our model was a strong predictor of worse 3-year survival (hazard ratio, 10.43; 95% confidence interval, 2.82–38.58; p < 0.001) and event-free survival (hazard ratio, 2.52; 95% confidence interval, 1.47–4.34; p < 0.001), with prognostic power comparable to the Japanese Cardiovascular Health Study criteria. Conclusions: A simplified frailty model incorporating gait speed, serum albumin, and grip strength provides robust diagnostic and prognostic utility. Its objectivity and ease of use may facilitate consistent preoperative risk stratification in patients undergoing cardiac surgery.