Does pre-operative frailty predict cardiac rehabilitation completion in cardiac surgery patients?
The typical cardiac surgery patient is increasing in age and level of frailty. Frailty can be defined as an increased vulnerability to stressors due to decreased physiological reserve. Previous investigations have demonstrated the benefit of cardiac rehabilitation (CR) programming on surgical outcomes. However, the link between pre-operative frailty and post-operative CR completion is unclear. The purpose of this study was to determine if pre-operative frailty status impacts CR completion post-operatively. A total of 114 cardiac surgery patients with an average age of 71 years were included in the analysis. CR completers were significantly less frail than CR non-completers at baseline based on the Clinical Frailty Scale (CFS; p=0.01), Modified Fried Criteria (MFC; p=0.0005), Short Physical Performance Battery (SPPB; p=0.007) and the Functional Frailty Index (FFI; p=<0.0001). The change in frailty status from baseline to 1-year post-operatively was not statistically different between CR completers and non-completers; CFS (p=0.90), MFC (p=0.70), SPPB (p=0.06) and FFI (p=0.07). However, the MFC frailty domains of cognitive impairment (p=0.0005) and low physical activity (p=0.04), in addition to the FFI physical domain of frailty (p=0.009), did significantly improve among CR completers when compared to non-completers. CR attendance measured by swipe card access did not correlate with frailty modifications. Collectively, these data suggest that participants deemed to be frail at the pre-operative time point attend and complete CR less frequently than non-frail participants. Furthermore, CR completion does not appear to modify frailty status overall; although, some frailty domains appear to be more sensitive to change than others.
Older Adult, Frailty, Cardiac Rehabilitation