Monday, 15 August 2011


Publication of this paper is good in one sense  - it is I hope the first of many studies examining and highlighting  the effect of frailty on outcomes after cardiac surgery.

Just because we can does not mean we have to - i.e. perform an open cardiac surgical procedure on an elderly frail patient. Cardiac surgeons should exercise restraint in picking who they operate on. There is nothing quite like cardiac surgery for testing biological reserve! Even cardiac surgeons cannot reverse the effect of ageing.
On the other hand, the research question posed by the authors is hardly ground breaking - Are frail elderly more likely to die 1 year after cardiac surgery than non frail elderly patients?  - I predict that they are more likely to die 1 year after a haircut!!
How one treats frail elderly patients with otherwise potentially operable cardiac disease will depend on which side of the cultural fence one stands on. In the UK, fatalistic/? realistic clinicians working within a cash strapped healthcare system will opt for palliation. Elsewhere, (in the US or Germany) they will opt for expensive new percutaneous toys!