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Five-Year Functional and Cognitive Trajectories Following Cardiac Surgery in Older Adults: A Prospective Study
Patrick F M Corbett1, Asma Sadoun2, Yuki Yoshimatsu1
1Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Insights
Older adults regain physical function after cardiac surgery, but cognitive decline persists long-term. Preoperative frailty and cognitive status predict recovery, aiding personalized care planning.
Area of Science:
- Geriatric Medicine
- Cardiovascular Surgery
- Neuroscience
Background:
- Older adults undergoing coronary artery bypass grafting (CABG) ± valve surgery face risks of poor functional and cognitive recovery.
- Preoperative factors influencing outcomes require identification for optimized perioperative strategies.
Purpose of the Study:
- To evaluate 5-year functional and cognitive outcomes in older adults post-CABG ± valve surgery.
- To identify preoperative predictors of suboptimal recovery in this population.
Main Methods:
- Prospective observational cohort study of patients aged ≥60 undergoing elective cardiac surgery.
- Assessment of frailty (Edmonton Frailty Scale), cognition (Montreal Cognitive Assessment), and function (NEADL, Barthel Index) preoperatively and at multiple follow-up points up to 5 years.
- Nonparametric tests, correlation, and regression analyses explored outcome associations.
Main Results:
- Operative mortality was 22.4% over 5 years. Survivors showed initial functional decline followed by recovery and improvement beyond baseline by 5 years.
- Cognitive performance progressively declined from baseline to 5 years (mean MoCA 25.8 to 18.7).
- Preoperative frailty (EFS >3) and cognitive impairment (MoCA ≤24) were associated with poorer early functional recovery and higher 5-year mortality.
Conclusions:
- While physical function recovers, older adults experience persistent postoperative cognitive decline after cardiac surgery.
- Preoperative frailty and cognitive assessments are crucial for identifying at-risk individuals.
- Integrating comprehensive geriatric assessments into cardiac surgical pathways is recommended for personalized perioperative planning.
Objectives:
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.
Design:
Prospective observational cohort study.
Setting And Participants:
Patients aged ≥60 scheduled for elective CABG ± valvular intervention at a tertiary cardiac surgery center in the United Kingdom.
Methods:
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.
Results:
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).
Conclusions And Implications:
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.
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