Priority 2 from the Heart Surgery PSP

UNCERTAINTY: How can we address frailty and improve the management of frail patients in heart surgery?  (JLA PSP Priority 2)
Overall ranking 2
JLA question ID 0088/2
Explanatory note Frailty is a topic frequently assessed in current Guidelines, recurring more often when management of chronic heart failure is explored. Albeit scientific literature recognizes the need for frailty assessment in guiding clinical practice, no consensus is in place even in terms of which score to use and currently used risk stratification tools as EuroSCORE II and STS score do not take account of it as a variable, as pointed out in the last ESC/EACTS Guidelines on myocardial revascularization. It can be clearly seen, therefore, how research would benefit from a scientifically stricter evaluation of the impact of frailty on cardiac surgery. ~ How to address and quantify frailty in heart surgery patients? Does frailty has implications for heart surgery patient and how it can help patients to choose treatment options?
Evidence

https://www.sign.ac.uk/sign-147-management-of-chronic-heart-failure.html;  Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg. 2019;55(1):4-90.; Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52(4):616-64. 
Health Research Classification System category Cardiovascular
Extra information provided by this PSP
Original uncertainty examples Does frailty has implications for heart surgery patient and how it can help patient to choose treatment options? ~ How to address and quantify frailty in heart surgery patients? ~ What is the long term benefit of complex surgery in frail patients with multiple co-morbidities?  
Submitted by 14 x healthcare professional, 1 x others
PSP information
PSP unique ID 0088
PSP name Heart Surgery
Total number of uncertainties identified by this PSP. 45  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 11 July 2019