The Relationship Between Frailty and Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

IF 0.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2025-11-07 DOI:10.1155/jocs/1336346

Tristan W. Dorey, Loryn J. Bohne, Ali Fatehi Hassanabad, Kaylene Duttchen, Stephen B. Wilton, Rosaleen Chun

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Abstract

Background

Postoperative atrial fibrillation (POAF) occurs in roughly one-third of patients undergoing cardiac surgery, increasing mortality, morbidity, and healthcare costs. Frailty, a syndrome of physiological decline, is associated with poor outcomes after cardiac surgery. The link between frailty and POAF has not been clearly established.

Methods

A systematic search of PubMed and EMBASE was conducted up to January 2025 for studies reporting preoperative frailty scores and POAF rates postcardiac surgery. Transcatheter aortic valve replacement (TAVR) studies were assessed separately. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) for frail vs. nonfrail patients were calculated using a random-effect model.

Results

Eighteen studies involving 9098 patients (undergoing coronary artery bypass, surgical valve replacement, or both) were included. Meta-analysis indicated that frailty was associated with a higher risk of POAF (RR 1.20; 95% CI 1.08–1.33, p = 0.0008). Subgroup analyses showed consistent frailty effects across different patient ages, study designs, surgery types, and sample sizes. Notably, POAF risk was higher in studies using clinical frailty scales (RR 1.33; 95% CI 1.15–1.54, p < 0.0001) compared to those using surrogate imaging/lab-based methods (RR 1.10; 95% CI 0.92–1.33, p = 0.24) though comparison between subgroups did not reach statistical significance (p = 0.08). In 3 studies for patients undergoing TAVR, there was no association between frailty and POAF (RR 1.24; 95% CI 0.81–1.88, p = 0.32).

Conclusion

This meta-analysis underscores the association between frailty and increased POAF risk in cardiac surgery patients, highlighting the need for comprehensive clinical frailty assessments in preoperative evaluations to identify high-risk patients and optimize perioperative management.

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心脏手术患者虚弱与术后房颤的关系：系统回顾和荟萃分析

背景：大约三分之一的心脏手术患者发生术后心房颤动（POAF），增加了死亡率、发病率和医疗费用。虚弱是一种生理机能下降的综合征，与心脏手术后不良预后相关。虚弱和POAF之间的联系还没有明确确立。方法系统检索PubMed和EMBASE，检索截至2025年1月的报告术前虚弱评分和心脏手术后POAF发生率的研究。经导管主动脉瓣置换术（TAVR）研究被单独评估。使用随机效应模型计算体弱与非体弱患者的合并风险比（rr）和95%置信区间（ci）。结果纳入18项研究，涉及9098例患者（接受冠状动脉搭桥术、手术瓣膜置换术或两者兼而有之）。荟萃分析显示，虚弱与POAF的高风险相关（RR 1.20; 95% CI 1.08-1.33, p = 0.0008）。亚组分析显示，在不同的患者年龄、研究设计、手术类型和样本量中，虚弱效应是一致的。值得注意的是，使用临床虚弱量表的研究中，POAF风险高于使用替代成像/实验室方法的研究（RR 1.33; 95% CI 1.15-1.54, p < 0.0001），但亚组间比较无统计学意义（p = 0.08）。在3项针对TAVR患者的研究中，虚弱和POAF之间没有相关性（RR 1.24; 95% CI 0.81-1.88, p = 0.32）。结论：本荟萃分析强调了心脏手术患者虚弱与POAF风险增加之间的关联，强调了术前评估中需要进行全面的临床虚弱评估，以识别高危患者并优化围手术期管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.