Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease.

Egle Tamuleviciute-Prasciene,Birna Bjarnason-Wehrens,Raimondas Kubilius,Greta Jurenaite,Kristina Drulyte

doi:10.1155/2018/9849475

Abstract

The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting results of exercise training in patients after surgical/interventional VHD treatment were analyzed regarding contents and outcomes. The tools for frailty assessment included fried phenotype frailty index and its modifications, multidimensional geriatric assessment, clinical frailty scale, 5-meter walking test, serum albumin levels, and Katz index of activities of daily living. Frailty assessment in CR settings should be based on functional, objective tests and should have similar components as tools for risk assessment (mobility, muscle mass and strength, independence in daily living, cognitive functions, nutrition, and anxiety and depression evaluation). Participating in comprehensive exercise-based CR could improve short- and long-term outcomes (better quality of life, physical and functional capacity) in frail VHD patients. Such CR program should be led by cardiologist, and its content should include (1) exercise training (endurance and strength training to improve muscle mass, strength, balance, and coordination), (2) nutrition counseling, (3) occupational therapy (to improve independency and cognitive function), (4) psychological counseling to ensure psychosocial health, and (5) social worker counseling (to improve independency). Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.

Highlights

Worldwide, the population is aging, and the associated challenges for the healthcare system are significant
Frailty assessment in cardiac rehabilitation (CR) settings should be based on functional, objective tests and should have similar components as tools for risk assessment
Are Assessment Tools Used for Frailty Screening Sensitive Enough to Show Improvement in Frailty Status after ExerciseBased CR? In order to answer first research question we describe most often used frailty tools for screening in patients with valvular heart disease (VHD) and compare results with frailty assessment methods used in a setting of CR

Summary

Introduction

The population is aging, and the associated challenges for the healthcare system are significant. There is a clear association between degenerative valve disease, older age, and increasing life expectancy [1, 2]. According to the Euro Heart Survey on Valvular Heart Disease (VHD), patients with diagnosed VHD are often older, with a higher prevalence of other cardiovascular risk factors and comorbidities [2]. The share of surgically treated elderly patients (≥80 years old) increased from 2.6-7% to 9.3-12% in a period of 10 years [3, 4]. Innovation in cardiac surgery techniques [5], advance in anesthesiology, and early postsurgery care led to a lower risk of cardiac surgery in elderly patients [4] and Records identified and screened for relevance

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