Coronary Angiography and Frailty: What do interventionalists and patients decide?
Presenter
Jeffrey Taylor, DO, University of Illinois at Chicago, Chicago, IL
Jeffrey Taylor, DO1, Ryan Bricknell1, Logan Schwarzman, MD2, Tiago Soltes, RN3 and Mladen I. Vidovich, M.D., FSCAI1, (1)University of Illinois at Chicago, Chicago, IL, (2)Harbor-UCLA Medical Center, Oak Park, CA, (3)Jesse Brown VA, Chicago, IL
Keywords: Complications, Coronary, Drug-eluting Stent (DES) and Quality
Background
Frailty has been a well-documented risk factor for increased morbidity and mortality in hospitalized patients. This quality improvement project utilized a nursing protocol to assess characteristics of frail participants (FPs) vs non-frail participants (NFPs) prior to coronary angiography (CA). The primary goal of this study was to identify baseline characteristics of FPs vs NFPs that impact decision making by interventional cardiologists to perform an intervention [PCI (Percutaneous Coronary Intervention) vs. CABG (Coronary Artery Bypass Graft) vs. medical therapy]. Methods
This is a prospective cohort study of CA participants at a single veteran affairs institution. From September 2019 through December 2020, catheterization lab nurses interviewed 184 pre-CA participants using the Risk Analysis Index Questionnaire (RAI-C). FPs received scores ≥16; NFPs <16. Patient characteristics were obtained through review of the electronic medical record. Interventional cardiologists were blinded to results of this study. Results
Of the 184 coronary angiography participants, 22.2% (N=41) were FPs (mean RAI-C: 21.0) and 77.8% (143) were NFPs (mean RAI-C: 9.91) (p<0.01). 54% (22) of FPs and 52% (75) of NFPs met criteria (p=0.40) for consideration of a PCI or CABG intervention. Among those meeting intervention criteria: 64% of FPs vs. 75% of NFPs received a PCI (p=0.33); 5% FPs vs. 12% NFPs received a CABG (p=0.25); and 31.8% of FPs vs. 13.3% of NFPs received medical management (p=0.058). FPs reported congestive heart failure (51% vs. 15%), kidney failure (34% vs. 6%), shortness of breath (54% vs. 4%), cancer (9% vs. 0%), poor appetite (21% vs. 0%), nursing home living (5% vs. 1%), and functional impairment (RAI-C Section D score: 0.61 vs. 0.12) more often than NFPs (p<0.01 for all). Conclusions
Trending towards statistical significance,
FPs are more likely to receive medical management than undergo CABG or PCI compared to NFPs. Theoretically, assessing frailty through a pre-procedure questionnaire could reduce unnecessary procedures in frail patients. However, it appears interventional cardiologists and patients may already tend to decide on less aggressive interventions in NFPs with obstructive coronary disease.