(P061) EXAMINING THE ASSOCIATION BETWEEN DOMAINS OF FRAILTY AND 6-MONTH CHANGES IN HEALTH-RELATED QUALITY OF LIFE, LIVING STATUS, AND TREATMENT DECISIONAL REGRET AMONG OLDER PATIENTS REFERRED FOR CARDIAC SURGERY

Background: Both age and frailty function as key preoperative risk factors for cardiac surgery. Age alone is usually a poor marker for predicting older patients’ health status, most likely due to failure to reflect functional status. Frailty status, which takes function into account, may be a better measure for older patients’ health status, although multiple operational definitions of this construct exist. A small number of studies have demonstrated that frailty is a risk factor for various adverse outcomes after cardiac surgery,

METHODS AND RESULTS: A prospective cohort pre-post design was used to evaluate the exposure (frailty) and resulting outcomes (change in HRQoL; dependent living status; treatment decisional regret). Frailty was assessed preoperatively using the FACT, a frailty instrument that categorizes frailty in domains of mobility, social circumstances, daily tasks, and cognition. The primary outcome was HRQoL, measured preoperatively and at 6 months using EQ-5D-3L/EQ-VAS. Secondary outcomes were, dependent living status and treatment decisional regret, measured using the Functional Independence questionnaire, both assessed at 6 months post-surgery. Worse ADL function was positively associated with higher levels of impairment in mobility and usual function HRQoL from baseline to 6 months. As well, worse ADL function was negatively associated with greater HRQoL improvement in men as measured by index scores and across all procedure types as measured by EQ-VAS. Worse mobility function was negatively associated with higher levels of improvement in HRQoL in isolated AVR patients. Lastly, those with worse ADL function had higher odds of experiencing a dependent living status 6 months after surgery (aOR = 2.06 (1.42, 3.00)), and worse ADL (aOR = 1.89 (1.35, 2.65) and cognitive (aOR = 1.77 (1.26, 2.47) function had higher odds of regretting their decision to have surgery

Conclusion: The current study showed domain-specific frailty, particularly poor pre-operative ADL function, is negatively associated with an individual’s capacity to return to optimal HRQoL post-operatively, independent living status and positively associated with experience of decisional regret. The evidence-based data has the potential to better inform patients who are at risk for loss of HRQoL and independence with cardiac surgery, allowing them to make decisions in line with values and preferences. Educating patients on the risks of frailty is an important aspect of patient-centered care and individualized prevention decision-making strategies based on patient priorities.