Original Title: Outils de dépistage de la fragilité chez les usagers subissant une intervention cardiaque nécessitant une sternotomie

Authors' objectives: In order to ensure that an invasive procedure’s risks and benefits are duly considered, and to obtain free and informed consent, it is necessary to be able to screen frail users at risk of major complications. In this context, the Department of General Medicine at the Quebec Heart and Lung Institute – Laval University requested the Health Technology Assessment Unit determine the best frailty screening methods for users undergoing heart surgery requiring a sternotomy.

Authors' results and conclusions: The literature search identified five systematic reviews, 35 non-randomized studies, and three evidence-based practice guidelines. Seven tools stand out from the literature in terms of quantity and quality of information, namely the five-item Fried scale, the seven-item Fried scale, the Edmonton Frailty Scale, the Essential Frailty Toolset, the Frailty Index, the Short Physical Performance Battery, and the five-meter walking speed test.

Authors' recommendations: It is recommended that decision-making integrate frailty screening with other risk factors and proven risk models. In users aged 70 and over undergoing cardiac surgery requiring a sternotomy, it is recommended to first screen for frailty using a rapid tool with high sensitivity. Then, to define the components of frailty in users showing a positive score, it is recommended that they be assessed using a second tool targeting complementary parameters. In the context where a user is identified as frail following the two-step evaluation, and the user should be eligible for cardiac intervention according to the attending physician, it is recommended that the user undergo a comprehensive geriatric assessment. This process will make it possible to make an informed decision concerning the risks inherent in surgery, or to redirect the user toward more appropriate treatments. Finally, it is recommended to follow up on postoperative outcomes relating to quality of life, functional decline, and delirium, with the results recorded in the file.

Project Status: Completed

URL for project: https://iucpq.qc.ca/fr/institut/qualite-et-performance/evaluation-des-technologies-et-modes-d-intervention-en-sante-etmis/accueil

Year Published: 2022

URL for published report: https://iucpq.qc.ca/sites/default/files/rap_evaluation_de_la_fragilite_v.2.0.pdf

Requestor: Department of General Medicine

English language abstract: There is no English language summary available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval (IUCPQ-ULaval)

Contact Address: 2725, chemin Sainte-Foy Québec QC G1V 4G5

Contact Name: uetmis.iucpq@ssss.gouv.qc.ca

Contact Email: uetmis.iucpq@ssss.gouv.qc.ca

Copyright: Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval