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PROTein to Enhance outComes of (Pre)Frail paTients Undergoing Cardiac Surgery

Cardiovascular Morbidity | Nutrition Poor | Frail Older Adult Syndrome

Heart disease in an aging population has resulted in heart surgery being offered to older and more frail patients. Frail patients which make up more than 50% of patients currently undergoing heart surgery are vulnerable to having long-recovery times after surgery, greater loss of independence (i.e. being admitted to a nursing home), experience more depression and anxiety, and have a worse quality of life. In fact, nearly 10% of frail, older adult patients die within 30 days after their heart surgery. The Investigators previous study found that weight-loss and poor muscle strength (i.e. weakness) of frail patients can lead to a worse recovery after heart surgery. Furthermore, inadequate nutrition (aka. malnutrition which is defined as an unintentional, nutritional intake imbalance (not necessarily a decreased intake) before an operation can lead to a vicious cycle of muscle loss causing more frailty, a desire to eat less leading to more muscle loss and increased frailty. At present there is no process to address this important issue in older adults undergoing heart surgery. The Investigators propose to study a practical, real-world, treatment plan that focuses on good nutrition to prevent muscle loss and reduced frailty in vulnerable heart surgery patients.

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Participation Requirements

  • Sex:

    ALL

  • Eligible Ages:

    60 and up

Participation Criteria

Inclusion Criteria:

1. Patients aged 60 years of age or older, undergoing elective isolated CABG, aortic valve repair or replacement for moderate aortic stenosis or severe regurgitation, mitral valve repair or replacement for moderate stenosis or severe regurgitation or combined CABG/valve procedures.
2. Patients with a Clinical Frailty Score (CFS) from 3 (Managing Well) to 7 (severely frail),
3. Patients with a Short Physical Performance Battery (SPPB) score of 9 or less, or an SF-36 (PF) score of \<= 60
4. Patients with an estimated wait time for elective cardiac surgery of 1 week or longer
5. Inpatients with an estimated wait time for non-emergent cardiac surgery of 2 days or longer from hospital admission

Exclusion Criteria:

1. Decompensated or non-ambulatory class IV symptoms of angina, dyspnea, claudication
2. Patients with a Clinical Frailty Score (CFS) of 7 or greater (Severely frail to terminally ill); this will exclude less than 1% of the population on the elective cardiac surgery waitlist.
3. Creatinine clearance \<30 mL/min/1.83 m2
4. Cirrhosis (Child-Pugh Class B or greater)
5. Allergy to milk proteins or other ingredients in the supplement
6. Inability to safely ingest beverage by mouth
7. Significant cognitive impairment (MoCA Score \< 16)
8. An inability to speak/read in English or French
9. Non-emergent or emergent surgery less than 2 days from hospital admission

Study Location

St. Boniface General Hospital
St. Boniface General Hospital
Winnipeg, Manitoba
Canada

Contact Study Team

Primary Contact

Rakesh Arora, MD,PhD

[email protected]
(204) 258-1078
Backup Contact

David Kent, MSc

[email protected]
204-237-2985
Jewish General Hospital
Jewish General Hospital
Montréal, Quebec
Canada

Contact Study Team

Primary Contact

Jonathan Afilalo, MD

[email protected]
(514) 340-8232
Backup Contact

Sarah Lantagne, MSc

[email protected]
(514) 340-8222
Study Sponsored By
St. Boniface Hospital
Participants Required
More Information
Study ID: NCT04038294