PMID- 33211104
OWN - NLM
STAT- MEDLINE
DCOM- 20210119
LR  - 20220716
IS  - 2574-3805 (Electronic)
IS  - 2574-3805 (Linking)
VI  - 3
IP  - 11
DP  - 2020 Nov 2
TI  - Association Between Wearable Device-Based Measures of Physical Frailty and Major 
      Adverse Events Following Lower Extremity Revascularization.
PG  - e2020161
LID - 10.1001/jamanetworkopen.2020.20161 [doi]
LID - e2020161
AB  - IMPORTANCE: Physical frailty is a key risk factor associated with higher rates of 
      major adverse events (MAEs) after surgery. Assessing physical frailty is often 
      challenging among patients with chronic limb-threatening ischemia (CLTI) who are 
      often unable to perform gait-based assessments because of the presence of plantar 
      wounds. OBJECTIVE: To test a frailty meter (FM) that does not rely on gait to 
      determine the risk of occurrence of MAEs after revascularization for patients 
      with CLTI. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 184 
      consecutively recruited patients with CLTI at 2 tertiary care centers. After 32 
      individuals were excluded, 152 participants were included in the study. Data 
      collection was conducted between May 2018 and June 2019. EXPOSURES: Physical 
      frailty measurement within 1 week before limb revascularization and incidence of 
      MAEs for as long as 1 month after surgery. MAIN OUTCOMES AND MEASURES: The FM 
      works by quantifying weakness, slowness, rigidity, and exhaustion during a 
      20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. 
      The FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate 
      progressively greater severity of physical frailty. RESULTS: Of 152 eligible 
      participants (mean [SD] age, 67.0 [11.8] years; 59 [38.8%] women), 119 (78.2%) 
      were unable to perform the gait test, while all could perform the FM test. 
      Overall, 53 (34.9%), 58 (38.1%), and 41 (27.0%) were classified as robust (FI 
      <0.20), prefrail (FI >/=0.20 to <0.35), or frail (FI >/=0.35), respectively. Within 
      30 days after surgery, 24 (15.7%) developed MAEs, either major adverse 
      cardiovascular events (MACE; 8 [5.2%]) or major adverse limb events (MALE; 16 
      [10.5%]). Baseline demographic characteristics were not significantly different 
      between frailty groups. In contrast, the FI was approximately 30% higher in the 
      group that developed MAEs (mean [SD] score, 0.36 [0.14]) than those who were MAE 
      free (mean [SD] score, 0.26 [0.13]; P = .001), with observed MAE rates of 4 
      patients (7.5%), 7 patients (12.1%), and 13 patients (31.7%) in the robust, 
      prefrail and frail groups, respectively (P = .004). The FI distinguished 
      individuals who developed MACE and MALE from those who were MAE free (MACE: mean 
      [SD] FI score, 0.38 [0.16]; P = .03; MALE: mean [SD] FI score, 0.35 [0.13]; 
      P = .004) after adjusting by body mass index. CONCLUSIONS AND RELEVANCE: In this 
      cohort study, measuring physical frailty using a wrist-worn sensor during a short 
      upper extremity test was a practical method for stratifying the risk of MAEs 
      following revascularization for CLTI when the administration of gait-based tests 
      is often challenging.
FAU - Najafi, Bijan
AU  - Najafi B
AD  - Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular 
      Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, Texas.
FAU - Veranyan, Narek
AU  - Veranyan N
AD  - Keck School of Medicine, University of Southern California, Los Angeles.
FAU - Zulbaran-Rojas, Alejandro
AU  - Zulbaran-Rojas A
AD  - Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular 
      Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, Texas.
FAU - Park, Catherine
AU  - Park C
AD  - Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular 
      Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, Texas.
FAU - Nguyen, Hung
AU  - Nguyen H
AD  - Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular 
      Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, Texas.
FAU - Nakahara, Quinn Kaleikaumaka
AU  - Nakahara QK
AD  - Keck School of Medicine, University of Southern California, Los Angeles.
FAU - Elizondo-Adamchik, Hector
AU  - Elizondo-Adamchik H
AD  - Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular 
      Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, Texas.
FAU - Chung, Jayer
AU  - Chung J
AD  - Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular 
      Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, Texas.
FAU - Mills, Joseph L
AU  - Mills JL
AD  - Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular 
      Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, Texas.
FAU - Montero-Baker, Miguel
AU  - Montero-Baker M
AD  - Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular 
      Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, Texas.
FAU - Armstrong, David G
AU  - Armstrong DG
AD  - Keck School of Medicine, University of Southern California, Los Angeles.
FAU - Rowe, Vincent
AU  - Rowe V
AD  - Keck School of Medicine, University of Southern California, Los Angeles.
LA  - eng
GR  - R21 CA190933/CA/NCI NIH HHS/United States
GR  - SB1 AG032748/AG/NIA NIH HHS/United States
GR  - UL1 TR001855/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20201102
PL  - United States
TA  - JAMA Netw Open
JT  - JAMA network open
JID - 101729235
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Female
MH  - Frail Elderly/*statistics & numerical data
MH  - Frailty/*diagnosis
MH  - Geriatric Assessment/methods/*statistics & numerical data
MH  - Humans
MH  - Lower Extremity/*surgery
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Physiologic/*instrumentation/statistics & numerical data
MH  - United States
MH  - Vascular Surgical Procedures/*adverse effects
MH  - Wearable Electronic Devices/*statistics & numerical data
PMC - PMC7677765
COIS- Conflict of Interest Disclosures: Dr Najafi reported being listed as a coinventor 
      of the frailty meter, which is protected by a patent (pending) belonging to the 
      University of Arizona; receiving personal fees from Biosensics; receiving grants 
      from EdenL, AVEX, EO2 COnceot, PulseFlow DF, LifeNet, and Avazzia; and receiving 
      grants and personal fees from Results Group and Hamad Medical Corporation outside 
      the submitted work. Dr Chung reported holding a patent to exergaming for the 
      prevention of venous thromboembolism. No other disclosures were reported.
EDAT- 2020/11/20 06:00
MHDA- 2021/01/20 06:00
PMCR- 2020/11/19
CRDT- 2020/11/19 12:14
PHST- 2020/11/19 12:14 [entrez]
PHST- 2020/11/20 06:00 [pubmed]
PHST- 2021/01/20 06:00 [medline]
PHST- 2020/11/19 00:00 [pmc-release]
AID - 2773096 [pii]
AID - zoi200696 [pii]
AID - 10.1001/jamanetworkopen.2020.20161 [doi]
PST - epublish
SO  - JAMA Netw Open. 2020 Nov 2;3(11):e2020161. doi: 
      10.1001/jamanetworkopen.2020.20161.