Evaluation and treatment frailty in hospitalized older adults with acute cardiac conditions
Bibliographic record
Abstract
Background: After an acute cardiac event or cardiac surgery, frail older adults are at risk of poor quality of life, nonfatal and fatal adverse events. Measuring frailty in acute cardiac care settings can provide valuable prognostic information to guide clinical decision-making and therapeutic interventions. To understand the benefits of screening and intervening on frailty in this setting, the objectives of this thesis were to determine the predictive value of rapid frailty screening tools (handgrip strength) and to design a pragmatic multidimensional intervention to improve functional recovery in frail hospitalized patients. Methods: The first project was a cohort study using data from the prospective McGill Frailty Registry to determine the predictive value of a rapid frailty screening tool (i.e. handgrip strength) in patients undergoing cardiac surgery. The second project was a randomized clinical trial to determine the therapeutic value of an intervention targeting deficits identified by a frailty screening tool in patients hospitalized for acute cardiac conditions (“TARGET-EFT”: The Multicomponent Acute Intervention in Frail Geriatric Patients with Cardiovascular Disease using the Essential Frailty Toolset).Results: The cohort study consisted of 1,245 cardiac surgery patients with a mean age of 74.0 ± 6.6 years. Weak handgrip strength was associated with higher risk of adverse outcomes and was predictive of 1-year and 30-day mortality (odds ratios of 2.44 (CI 1.39, 4.29) and 2.83 (CI 1.38, 5.81), respectively). The TARGET-EFT randomized trial consists of 130 frail hospitalized cardiac patients (out of a planned sample size of 144). Preliminary data analysis on the initial 77 patients with a mean age of 80 years showed that average length of stay was 8 days. Of the 39 intervention patients, 94% of patients requiring exercise, 100% of patients requiring cognitive stimulation, 86% of patients requiring intravenous iron sucrose and 81% patients requiring protein supplementation, received the minimum dose of interventions by discharge. Patients received an average of 6 exercise sessions, with 46% of sessions not being performed due to hospitalization-associated factors. We did not report intervention-related adverse events or injuries. The TARGET-EFT trial appears to be safe and feasible for frail patients hospitalized with acute cardiac conditions.Conclusions: The assessment of frailty with rapid screening tools can easily identify patients who would benefit from a comprehensive geriatric assessment and multicomponent in-hospital interventions that aim to treat frailty and improve patient-centered outcomes. The results of the TARGET-EFT trial will inform practice guidelines on therapeutic interventions and frailty management in older adults with acute cardiac conditions
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".