Prevention & lipidsCohort study
Frailty assessment and the risk of major adverse cardiovascular events after elective surgery
- retrospective cohort study
- propensity-matched 1:1
Authors' conclusion
Frailty before non-cardiac surgery was associated with increased 30-day MACE. Incorporating frailty into RCRI improves risk prediction, particularly for patients with low baseline cardiac risk.
Study context
- Population
- Older US adults insured through Medicare undergoing non-cardiac surgery between January 2015 and September 2021mean age 73 years, 43% male, 22.4% had intermediate/high frailty
- Participants
- 6,399,535 adults
- Exposure
- intermediate/high frailty vs low-frailty
- Outcome
- MACE:
- Mortality
- Myocardial infarction
- Stroke
- Heart failure
- Follow-up
- 30-day
Main finding
As reported in the abstract
Odds ratio
1.19
95% CI 1.17–1.21
P < 0.001
intermediate/high frailty vs low-frailty
OR 1.19 (95% CI 1.17–1.21); P < 0.001
- experienced 30-day major adverse cardiovascular events (MACE) (overall cohort)
- 2.97%
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Mortality · 30-day · propensity-matched cohort | 1.53 (1.49–1.58) | P < 0.001 | |
| 30-day MACE by baseline cardiac risk (subgroup) — intermediate/high frailty vs low-frailty · RCRI 0-1 | 1.28 (1.25–1.31) | ||
| 30-day MACE by baseline cardiac risk (subgroup) — intermediate/high frailty vs low-frailty · RCRI 2-4 | 1.06 (1.03–1.09) | ||
| 0.512Odds ratio (log scale) |
| Outcome | Estimate | P value |
|---|---|---|
| Predictive performance for 30-day MACE, RCRI with frailty vs. RCRI — RCRI with frailty vs RCRI | C-index 0.773 vs. 0.758 | P < 0.001 |
| Predictive performance for 30-day MACE, RCRI with frailty vs. RCRI — RCRI with frailty vs RCRI | Brier score 0.0277 vs. 0.0290 |
- 30-day MACE by baseline cardiac risk (subgroup): Pinteraction < 0.001
Original publication
Frailty assessment and the risk of major adverse cardiovascular events after elective surgery. Eur Heart J Acute Cardiovasc Care. Published 19 August 2026. doi:10.1093/ehjacc/zuag108
Summarised from the published abstract; every number is checked against it