Pre-Operative Frailty Status Is Associated with Cardiac Rehabilitation Completion: A Retrospective Cohort Study.

Brett Hiebert,Carly Fraser,Jacqueline Hay,Naomi Hamm,Andrew Stammers,Patrick Jung,Kevin Boreskie,D Kehler,Dustin Kimber,James Lytwyn,Mekayla Clarke,Navdeep Tangri,Todd Duhamel,Bryce Alexander,Brittany Pedreira,Rakesh Arora,Chris Dubiel

doi:10.3390/jcm7120560

Brett Hiebert, Carly Fraser + Show 15 more

Open Access

https://doi.org/10.3390/jcm7120560

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Abstract

While previous investigations have demonstrated the benefit of cardiac rehabilitation (CR) on outcomes after cardiac surgery, the association between pre-operative frailty and post-operative CR completion is unclear. The purpose of this retrospective cohort study was to determine if pre-operative frailty scores impacted CR completion post-operatively and if CR completion influenced frailty scores in 114 cardiac surgery patients. Frailty was assessed with the use of the Clinical Frailty Scale (CFS), the Modified Fried Criteria (MFC), the Short Physical Performance Battery (SPPB), and the Functional Frailty Index (FFI). A Mann-Whitney test was used to compare frailty scores between CR completers and non-completers and changes in frailty scores from baseline to 1-year post-operation. CR non-completers were more frail than CR completers at pre-operative baseline based on the CFS (p = 0.01), MFC (p < 0.001), SPPB (p = 0.007), and the FFI (p < 0.001). A change in frailty scores from baseline to 1-year post-operation was not detected in either group using any of the four frailty assessments. However, greater improvements from baseline to 1-year post-operation in two MFC domains (cognitive impairment and low physical activity) and the physical domain of the FFI were found in CR completers as compared to CR non-completers. These data suggest that pre-operative frailty assessments have the potential to identify participants who are less likely to attend and complete CR. The data also suggest that frailty assessment tools need further refinement, as physical domains of frailty function appear to be more sensitive to change following CR than other domains of frailty.

Highlights

By the year 2051, it is estimated that 25% of the Canadian population will be ≥65 years of age [1]
These results were supported by multivariable regression models, where a 1-point increase in the Modified Fried Criteria (MFC), Clinical Frailty Scale (CFS), or Functional Frailty Index (FFI) was associated with odds ratios of 0.68 (0.52–0.88 95% CI, p = 0.03), 0.65 (0.44–0.96 95% CI, p = 0.03), and 0.41 (0.26–0.67 95% CI, p < 0.01), respectively, for completing cardiac rehabilitation (CR) after controlling for age and EuroSCORE II
The lower likelihood of frail cardiac surgery patients attending CR is problematic because cardiac surgery patients who are frail pre-operatively are at an increased risk of post-operative mortality, morbidity, functional decline, as well as major adverse cardiac and cerebrovascular events post-cardiac surgery when compared to robust patients [5]

Summary

Introduction

By the year 2051, it is estimated that 25% of the Canadian population will be ≥65 years of age [1]. Improvements in cardiac surgical techniques over the past two decades have decreased operative mortality rates despite an older and increasingly frail cardiac surgery population [2]. CR is a multidisciplinary approach that involves behavior change, risk factor control, exercise, psychological support, and diet education [6]. Those who complete a CR program following their cardiac surgery have improved lipid profiles and reduced risk of all-cause and cardiac mortality when compared to those who do not [7,8]. The purpose of this study was to determine the impact of pre-operative frailty on CR completion rates. We hypothesized that pre-operative frailty negatively impacts CR completion rates

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