FraiLTI (Frailty in Chronic Limb-Threatening Ischaemia)

Cohort study, UK-only, Multi-centre
Primary Investigator: Sandip Nandhra
Funding: NIHR, Newcastle Hospitals Charity
Start date: 01/09/2021
End date: 30/09/2022

A UK-wide, multi-centre prospective observational study evaluating the impact of frailty, sarcopenia and multi-morbidity on outcomes following vascular intervention for Chronic limb threatening ischaemia (CLTI).

CLTI is a patient-led James-Lind Alliance priority for vascular research, and limb-loss due to vascular disease is unfortunately a common consequence. Many of these patients also suffer from multiple conditions and frailty; a health challenge that brings increased vulnerability to illness and inferior clinical outcomes following some types of surgery.

A key component of frailty is sarcopenia – skeletal muscle dysfunction that develops over a period of time and typically affects older patients, leading to reduced strength and muscle mass. Some evidence exists that sarcopenia alone leads to worse survival following endovascular surgery and following elective joint replacement. The association of frailty and the interaction with sarcopenia is not fully understood, nor is the the interaction within high risk CLTI patients. Some of our published work suggest that sarcopenic CLTI patients undergoing revascularisation surgery have worse short-term outcomes in terms of limb-loss and survival.

Multiple long-term conditions (multimorbidity) is also an important factor potentially affecting outcomes, and there is a need to examine the impact of this, independent of age.

The FraiLTI study has been developed to assess the nationwide scale of the problem and and to develop a platform on which to build future intervention studies to mitigate the impact of frailty, sarcopenia and multimorbidity in this group of patients.

The NIHR Newcastle BRC grant is pivotal to the study’s success. It will provide funding for databases, assessment tools and study fees.

The study is set to be one of the largest of its kind, with over 12 UK vascular sites signed up to participate, and with support from the Vascular and Endovascular Research Network.