Pre-Operative Frailty Status Is Associated with Cardiac Rehabilitation Completion: A Retrospective Cohort Study
Pre-Operative Frailty Status Is Associated with Cardiac Rehabilitation Completion: A Retrospective Cohort Study
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DOI：
10.3390/jcm7120560
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发表时间：
2018-12-01
影响因子：
3.9
通讯作者：
Duhamel, Todd A.
中科院分区：
文献类型：
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作者：
Kimber, Dustin E.;Kehler, D. Scott;Duhamel, Todd A.
虽然先前的研究已经证明心脏康复（CR）对心脏手术后的预后有好处，但术前虚弱和术后CR完成之间的关系尚不清楚。本回顾性队列研究的目的是确定114例心脏手术患者术前虚弱评分是否影响术后CR的完成以及CR的完成是否影响虚弱评分。使用临床虚弱量表（CFS）、改良Fried标准（MFC）、短物理性能测试（SPPB）和功能虚弱指数（FFI）评估虚弱程度。采用Mann-Whitney检验比较CR完成者和非完成者的衰弱评分，以及从基线到术后1年衰弱评分的变化。基于CFS （p = 0.01）、MFC （p < 0.001）、SPPB （p = 0.007）和FFI (p < 0.001)，术前基线时CR未完成者比CR完成者更虚弱。使用四种衰弱评估中的任何一种，两组从基线到术后1年的衰弱评分均未发现变化。然而，从基线到术后1年，在两个MFC领域（认知障碍和低体力活动）和FFI的物理领域，CR完成者与CR未完成者相比有更大的改善。这些数据表明，术前虚弱评估有可能识别出不太可能参加和完成CR的参与者。数据还表明，虚弱评估工具需要进一步完善，因为虚弱功能的物理领域似乎比其他虚弱领域对CR后的变化更敏感。
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.