3 research outputs found
Frailty factors and outcomes in vascular surgery patients: a systematic review and meta-analysis
Objective To describe and critique tools used to assess frailty in vascular surgery patients, and
investigate its associations with patient factors and outcomes. Background Increasing evidence shows negative impacts of frailty on outcomes in surgical
patients, but little investigation of its associations with patient factors has been
undertaken.
Methods Systematic review and meta-analysis of studies reporting frailty in vascular surgery
patients (PROSPERO registration: CRD42018116253) searching Medline, Embase,
CINAHL, PsycINFO and Scopus. Quality of studies was assessed using Newcastle Ottawa scores (NOS) and quality of evidence using GRADE criteria. Associations of
frailty with patient factors were investigated by difference in means (MD) or
expressed as risk ratios (RR), and associations with outcomes expressed as odds
ratios (OR) or hazard ratios (HR). Data were pooled using random effects models.
Results Fifty-three studies were included in the review and only 8 (15%) were both good
quality (NOS β₯7) and used a well-validated frailty measure. Eighteen studies (62,976
patients) provided data for the meta-analysis. Frailty was associated with increased
age (MD 4.05 years; 95% confidence interval [CI] 3.35, 4.75), female sex (RR 1.32;
95%CI 1.14, 1.54), and lower body-mass index (MD -1.81; 95%CI -2.94, -0.68).
Frailty was associated with 30-day mortality (adjusted [A]OR 2.77; 95%CI 2.01-3.81),
post-operative complications (AOR 2.16; 95%CI 1.55, 3.02) and long-term mortality
(HR 1.85; 95%CI 1.31, 2.62). Sarcopenia was not associated with any outcomes. Conclusion Frailty, but not sarcopenia, is associated with worse outcomes in vascular surgery
patients. Well-validated frailty assessment tools should be preferred clinically, and in
future research.</div
Device-measured physical activity behaviours, and physical function, in people with type 2 diabetes mellitus and peripheral artery disease: A cross-sectional study
Aim: To quantify differences in device-measured physical activity (PA) behaviours, and physical function (PF), in people with type 2 diabetes mellitus (T2DM) with and without peripheral artery disease (PAD). Materials and methods: Participants from the Chronotype of Patients with T2DM and Effect on Glycaemic Control cross-sectional study wore accelerometers on their non-dominant wrist for up to 8-days to quantify: volume and intensity distribution of PA, time spent inactive, time in light PA, moderate-to-vigorous PA in at least 1-minute bouts (MVPA1min), and the average intensity achieved during the most active continuous 2, 5, 10, 30, and 60-minute periods of the 24-h day. PF was assessed using the short physical performance battery (SPPB), the Duke Activity Status Index (DASI), sit-to-stand repetitions in 60 s (STS-60); hand-grip strength was also assessed. Differences between subjects with and without PAD were estimated using regressions adjusted for possible confounders. Results: 736 participants with T2DM (without diabetic foot ulcers) were included in the analysis, 689 had no PAD. People with T2DM and PAD undertake less PA (MVPA1min: β9.2 min [95 % CI: β15.3 to β3.0; p = 0.004]) (light intensity PA: β18.7 min [β36.4 to β1.0; p = 0.039]), spend more time inactive (49.2 min [12.1 to 86.2; p = 0.009]), and have reduced PF (SPPB score: β1.6 [β2.5 to β0.8; p = 0.001]) (DASI score: β14.8 [β19.8 to β9.8; p = 0.001]) (STS-60 repetitions: β7.1 [β10.5 to β3.8; p = 0.001]) compared to people without; some differences in PA were attenuated by confounders. Reduced intensity of activity for the most active continuous 2β30 min in the 24-h day, and reduced PF, persisted after accounting for confounders. There were no significant differences in hand-grip strength. Conclusions: Findings from this cross-sectional study suggest that, the presence of PAD in T2DM may have been associated with lower PA levels and PF.</p
Leg Ischaemia Management collaboration (LIMb): study protocol for a prospective cohort study at a single UK centre
Introduction
Severe limb ischaemia (SLI) is the end-stage of peripheral arterial occlusive disease where
the viability of the limb is threatened. Around 25% of patients with SLI will ultimately
require a major lower limb amputation which has a substantial adverse impact on quality of
life. A newly established rapid-access vascular limb salvage clinic and modern
revascularisation techniques may reduce amputation rate. The aim of this study is to
investigate the 12-month amputation rate in a contemporary cohort of patients and
compare this to a historical cohort. Secondary aims are to investigate the use of frailty and
cognitive assessments, and cardiac MRI in risk-stratifying patients with SLI undergoing
intervention and establish a biobank for future biomarker analyses.
Methods & analysis
This single-centre prospective cohort study will recruit patients aged 18-110 years
presenting with SLI. Those undergoing intervention will be eligible to undergo additional
venepuncture (for biomarker analysis) and/or cardiac MRI. Those aged β₯65 years and
undergoing intervention will also be eligible to undergo additional frailty and cognitive
assessments. Follow-up will be at 12 and 24 months and subsequently via data-linkage with
NHS digital to 10 years post-recruitment. Those undergoing cardiac MRI and/or frailty
assessments will receive additional follow-up during the first 12 months to investigate for
peri-operative myocardial infarction and frailty related outcomes, respectively. A sample
size of 420 patients will be required to detect a 10% reduction in amputation rate in
comparison to a similar sized historical cohort, with 90% power and 5% type-I error rate.
Statistical analysis of this comparison will be by adjusted and unadjusted logistic regression
analyses.
Ethics & dissemination
Ethical approval for this study has been granted by the UK National Research Ethics Service
(19/LO/0132). Results will be disseminated to participants, via scientific meetings, peerreviewed medical journals and social media.
Study registration
ClinicalTrials.gov [NCT04027244