{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:10:25Z","timestamp":1790100625262,"version":"4.0.1"},"reference-count":51,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Frailty may increase the risk of major adverse cardiovascular events (MACE) after non-cardiac surgery. We aimed to assess the association between frailty and MACE after non-cardiac surgery and potential improvements in the performance of the Revised Cardiac Risk Index (RCRI) with the addition of frailty status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of older US adults insured through Medicare undergoing non-cardiac surgery between January 2015 and September 2021. Frailty was assessed with the Hospital Frailty Risk Score, categorized as low (&amp;lt;5), intermediate (5\u201314), and high (\u226515). The primary outcome was 30-day MACE (mortality, myocardial infarction, stroke, or heart failure). Patients with intermediate\/high frailty were propensity-matched 1:1 with low-frailty patients with exact match on age, sex, race, surgical procedure, and RCRI. The incremental utility of adding categorical frailty to RCRI was assessed by comparing concordance statistics and receiver operating characteristics. Among 6 399 535 patients (mean age 73 years, 43% male), 22.4% had intermediate\/high frailty and 2.97% experienced 30-day MACE. In the propensity-matched cohort, frailty was associated with higher odds of 30-day MACE [OR (95% CI): 1.19 (1.17\u20131.21), P &amp;lt; 0.001] and mortality [OR (95% CI): 1.53 (1.49\u20131.58), P &amp;lt; 0.001]. The association of frailty with MACE was stronger in patients with low baseline cardiac risk [RCRI 0\u20131: OR (95% CI): 1.28 (1.25\u20131.31)] vs. high risk [RCRI 2\u20134: OR (95% CI): 1.06 (1.03\u20131.09); Pinteraction &amp;lt; 0.001]. Adding frailty to RCRI improved predictive performance for 30-day MACE (C-index: 0.773 vs. 0.758, P &amp;lt; 0.001; Brier score: 0.0277 vs. 0.0290).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuag108","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T11:35:56Z","timestamp":1787052956000},"source":"Crossref","is-referenced-by-count":0,"title":["Frailty assessment and the risk of major adverse cardiovascular events after elective surgery"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8041-7302","authenticated-orcid":false,"given":"Bhavik","family":"Bansal","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, UT Southwestern Medical Center , 5323 Harry Hines Boulevard, Dallas, TX 75390, 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9500 Euclid Ave, Cleveland, OH 44195 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4074-793X","authenticated-orcid":false,"given":"Khaled","family":"Ziada","sequence":"additional","affiliation":[{"name":"Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation , 9500 Euclid Ave, Cleveland, OH 44195 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2196-2296","authenticated-orcid":false,"given":"Sarah","family":"Wingfield","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, UT Southwestern Medical Center , Dallas, TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safia","family":"Chatur","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Massachusetts General Hospital, Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7329-8918","authenticated-orcid":false,"given":"Gordon R","family":"Reeves","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of North Carolina School of Medicine , Chapel Hill, NC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5697-2189","authenticated-orcid":false,"given":"Daniel E","family":"Forman","sequence":"additional","affiliation":[{"name":"Department of Medicine , University of Maryland School of Medicine, Baltimore, MD, USA"},{"name":"VA Maryland Health Care System Baltimore Geriatric Research, Education, and Clinical Center (GRECC), , Baltimore, MD 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