Five-Year Functional and Cognitive Trajectories Following Cardiac Surgery in Older Adults: A Prospective Study

To describe the 5-year functional and cognitive outcomes of older adults undergoing coronary artery bypass grafting (CABG) ± valve surgery, and to identify preoperative factors associated with poor recovery.

Prospective observational cohort study.

Patients aged ≥60 scheduled for elective CABG ± valvular intervention at a tertiary cardiac surgery center in the United Kingdom.

Frailty [Edmonton Frailty Scale (EFS)], cognitive function (Montreal Cognitive Assessment, MoCA), functional status (Nottingham Extended Activities of Daily Living Scale, NEADL; Barthel Index), and quality of life (EuroQol-5 Dimension 3-Level; Dartmouth Cooperative Functional Assessment Charts) were assessed preoperatively and at discharge, 6 weeks, 6 months, and 5 years. Associations were explored using nonparametric tests, correlation analyses, and simple regression models.

Ninety-eight patients underwent surgery with a 5-year operative mortality of 22.4%. In survivors, functional status (NEADL) declined immediately postoperatively but recovered by 6 months and exceeded baseline levels at 5 years. Cognitive performance progressively declined from baseline to 5 years (mean MoCA 25.8 vs 18.7). Frailty (EFS >3) was associated with higher 5-year mortality (P = .048). Preoperative cognitive impairment (MoCA ≤24) was associated with poorer early functional recovery and significantly lower NEADL scores at 6 weeks (P = .043). Baseline frailty (EFS >3) was also associated with slower early recovery, with lower NEADL scores at 6 weeks (P = .041) and 6 months (P < .001).

Although physical function improves following cardiac surgery in older adults, postoperative cognitive decline is progressive and persistent. Preoperative frailty and cognitive assessment can help identify individuals at risk of poor functional recovery and inform personalized perioperative planning. Findings support the integration of comprehensive geriatric assessments into cardiac surgical pathways.