1
|
MacEachern E, Quach J, Giacomantonio N, Theou O, Hillier T, Abel-Adegbite I, Gonzalez-Lara M, Kehler DS. Cardiac rehabilitation and frailty: a systematic review and meta-analysis. Eur J Prev Cardiol 2024; 31:1960-1976. [PMID: 39036978 DOI: 10.1093/eurjpc/zwae239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/05/2024] [Accepted: 07/21/2024] [Indexed: 07/23/2024]
Abstract
AIMS Frailty among cardiac rehabilitation (CR) participants is associated with worse health outcomes. However, no literature synthesis has quantified the relationship between frailty and CR outcomes. The purpose of this study was to examine frailty prevalence at CR admission, frailty changes during CR, and whether frailty is associated with adverse outcomes following CR. METHODS AND RESULTS We searched CINAHL, EMBASE, and MEDLINE for studies published from 2000 to 2023. Eligible studies included a validated frailty measure, published in English. Two reviewers independently screened articles and abstracted data. Outcome measures included admission frailty prevalence, frailty and physical function changes, and post-CR hospitalization and mortality. Observational and randomized trials were meta-analysed separately using inverse variance random-effects models. In total, 34 peer reviewed articles (26 observational, 8 randomized trials; 19 360 participants) were included. Admission frailty prevalence was 46% [95% CI 29-62%] and 40% [95% CI 28-52%] as measured by Frailty Index and Kihon Checklist (14 studies) and Frailty Phenotype (11 studies), respectively. Frailty improved following CR participation (standardized mean difference (SMD): 0.68, 95% CI 0.37-0.99; P < 0.0001; six studies). Meta-analysis of observational studies revealed higher admission frailty and increased participants' risk of all-cause mortality (hazard ratio: 9.24, 95% CI 2.93-29.16; P = 0.0001; four studies). Frailer participants at admission had worse physical health outcomes, but improved over the course of CR. CONCLUSION High variability in frailty tools and CR designs was observed, and randomized controlled trial contributions were limited. The prevalence of frailty is high in CR and is associated with greater mortality risk; however, CR improves frailty and physical health outcomes. REGISTRATION PROSPERO: CRD42022311765.
Collapse
Affiliation(s)
- Evan MacEachern
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Dalhousie University Forrest Building, Room 402, PO Box 15000, Halifax, NS B3H 4R2, Canada
| | - Jack Quach
- Faculty of Health, Dalhousie University, 5868 College Street, Room 316, PO Box 15000, Halifax, NS B3H 4R2, Canada
| | | | - Olga Theou
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Dalhousie University Forrest Building, Room 402, PO Box 15000, Halifax, NS B3H 4R2, Canada
- Faculty of Health, Dalhousie University, 5868 College Street, Room 316, PO Box 15000, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Troy Hillier
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Ifedayo Abel-Adegbite
- Faculty of Health, Dalhousie University, 5868 College Street, Room 316, PO Box 15000, Halifax, NS B3H 4R2, Canada
| | - Mariana Gonzalez-Lara
- Faculty of Health, Dalhousie University, 5868 College Street, Room 316, PO Box 15000, Halifax, NS B3H 4R2, Canada
| | - Dustin Scott Kehler
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Dalhousie University Forrest Building, Room 402, PO Box 15000, Halifax, NS B3H 4R2, Canada
- Faculty of Health, Dalhousie University, 5868 College Street, Room 316, PO Box 15000, Halifax, NS B3H 4R2, Canada
| |
Collapse
|
2
|
Wong CWY, Li PWC, Yu DSF, Ho BMH, Chan BS. Estimated prevalence of frailty and prefrailty in patients undergoing coronary artery or valvular surgeries/procedures: A systematic review and proportional meta-analysis. Ageing Res Rev 2024; 96:102266. [PMID: 38462047 DOI: 10.1016/j.arr.2024.102266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The aging population has led to an increasing number of older patients undergoing cardiac surgeries/procedures. Frailty and prefrailty have emerged as important prognostic indicators among these patients. This proportional meta-analysis estimated the prevalence of frailty and prefrailty among patients undergoing cardiac surgery. METHODS We searched seven electronic databases for observational studies that used validated measure(s) of frailty and reported prevalence data on frailty and/or prefrailty in older patients undergoing coronary artery or valvular surgeries or transcatheter procedures. Meta-analyses were performed using a random-effects model. RESULTS One hundred and one articles involving 626,863 patients were included. The pooled prevalence rates of frailty and prefrailty were 28% (95% confidence interval [CI]: 23%-33%) and 40% (95% CI: 31%-50%), respectively, for patients scheduled for open-heart surgeries and 40% (95% CI: 36%-45%) and 43% (95% CI: 34%-53%), respectively, for patients undergoing transcatheter procedures. Frailty measured using a multidimensional approach identified a higher proportion of frail patients when compared with measures solely focused on physical frailty. Older age, female sex, and lower body mass index and hemoglobin concentrations were significantly associated with higher frailty prevalence. Moreover, countries with higher gross domestic product spent on healthcare exhibited a higher frailty prevalence. CONCLUSION Frailty represents a considerable health challenge among patients undergoing cardiac surgeries/procedures. Routine screening for frailty should be considered during perioperative care planning.
Collapse
Affiliation(s)
- Cathy W Y Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Polly W C Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Benjamin M H Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Bernice Shinyi Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| |
Collapse
|
3
|
Wasilewski M, Vijayakumar A, Szigeti Z, Sathakaran S, Wang KW, Saporta A, Hitzig SL. Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review. J Multidiscip Healthc 2023; 16:2361-2376. [PMID: 37605772 PMCID: PMC10440091 DOI: 10.2147/jmdh.s418803] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Objective The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR). Methods A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted. Results The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices. Conclusion ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.
Collapse
Affiliation(s)
- Marina Wasilewski
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Abirami Vijayakumar
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Zara Szigeti
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sahana Sathakaran
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Adam Saporta
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sander L Hitzig
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| |
Collapse
|
4
|
Quach J, Kehler DS, Giacomantonio N, McArthur C, Blanchard C, Firth W, Rockwood K, Theou O. Association of admission frailty and frailty changes during cardiac rehabilitation with 5-year outcomes. Eur J Prev Cardiol 2023; 30:807-819. [PMID: 36799963 PMCID: PMC10335868 DOI: 10.1093/eurjpc/zwad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Abstract
AIMS Examine the association between (1) admission frailty and (2) frailty changes during cardiac rehabilitation (CR) with 5-year outcomes (i.e. time to mortality, first hospitalization, first emergency department (ED) visit, and number of hospitalizations, hospital days, and ED visits). METHODS AND RESULTS Data from patients admitted to a 12-week CR programme in Halifax, Nova Scotia, from May 2005 to April 2015 (n = 3371) were analysed. A 25-item frailty index (FI) estimated frailty levels at CR admission and completion. FI improvements were determined by calculating the difference between admission and discharge FI. CR data were linked to administrative health data to examine 5-year outcomes [due to all causes and cardiovascular diseases (CVDs)]. Cox regression, Fine-Gray models, and negative binomial hurdle models were used to determine the association between FI and outcomes. On average, patients were 61.9 (SD: 10.7) years old and 74% were male. Mean admission FI scores were 0.34 (SD: 0.13), which improved by 0.07 (SD: 0.09) by CR completion. Admission FI was associated with time to mortality [HRs/IRRs per 0.01 FI increase: all causes = 1.02(95% CI 1.01,1.04); CVD = 1.03(1.02,1.05)], hospitalization [all causes = 1.02(1.01,1.02); CVD = 1.02(1.01,1.02)], ED visit [all causes = 1.01(1.00,1.01)], and the number of hospitalizations [all causes = 1.02(95% CI 1.01,1.03); CVD = 1.02(1.00,1.04)], hospital days [all causes = 1.01(1.01,1.03)], and ED visits [all causes = 1.02(1.02,1.03)]. FI improvements during CR had a protective effect regarding time to all-cause hospitalization [0.99(0.98,0.99)] but were not associated with other outcomes. CONCLUSION Frailty status at CR admission was related to long-term adverse outcomes. Frailty improvements during CR were associated with delayed all-cause hospitalization, in which a larger effect was associated with a greater chance of improved outcome.
Collapse
Affiliation(s)
- Jack Quach
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Dustin Scott Kehler
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Nicholas Giacomantonio
- Division of Cardiology, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7, Canada
- Department of Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
| | - Chris Blanchard
- Department of Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Wanda Firth
- Queen Elizabeth II Health Sciences Centre, Heart Health, 1276 South Park St, Halifax, NS B3H 2Y9, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| |
Collapse
|
5
|
The Role of Surgical Prehabilitation During the COVID-19 Pandemic and Beyond. Phys Med Rehabil Clin N Am 2023. [PMCID: PMC10070767 DOI: 10.1016/j.pmr.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
|
6
|
Impact of Oral Health Status on Postoperative Complications and Functional Recovery After Cardiovascular Surgery. CJC Open 2020; 3:276-284. [PMID: 33778444 PMCID: PMC7984977 DOI: 10.1016/j.cjco.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background Poor oral health status can lead to a deteriorated level of general health and is common among patients undergoing cardiovascular surgery. However, the effect of oral health status on postoperative outcomes in cardiovascular surgery patients remains unclear. Thus, we investigated the effect of preoperative oral health status on postoperative complications and functional recovery after cardiovascular surgery. Methods This single-centre retrospective cohort study included 884 inpatients undergoing elective cardiovascular surgery. Oral health status was assessed based on the number of remaining teeth, use of dentures, occlusal support, and periodontal status. We investigated postoperative complications related to surgery and postoperative functional recovery by measuring the reacquisition of walking ability, activities of daily living, and length of postoperative hospital stay. Results In this cohort (age 66.9 ± 13.4 years), the mean number of remaining teeth was 18.7 ± 9.4. Patients were grouped based on tertiles of the data distribution of remaining teeth: ≥ 20 teeth (470 patients); 10-19 teeth (137 patients); < 10 teeth (185 patients). The number of missing teeth was associated with age (P < 0.001). The prevalence of postoperative pneumonia and reintubation after surgery was 3.2% and 2.5%, respectively, which was significantly higher in patients with severe tooth loss (P < 0.05 for both). After adjusting for age and other confounding factors, the number of remaining teeth was a statistically significant predictor of functional recovery (P < 0.05). Conclusions Preoperative oral health status was related to postoperative respiratory complications and independently associated with functional recovery. Preoperative oral intervention may improve functional recovery after cardiovascular surgery.
Collapse
|
7
|
Frailty Status and Transport Disadvantage: Comparison of Older Adults' Travel Behaviours between Metropolitan, Suburban, and Rural Areas of Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176367. [PMID: 32882994 PMCID: PMC7504364 DOI: 10.3390/ijerph17176367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 01/27/2023]
Abstract
This study examined differences in older adults’ travel behaviours by frailty status in metropolitan, suburban, and rural areas of Japan. Data were collected from 9104 older adults (73.5 ± 5.7 years; 51% women; 19% frail) living in metropolitan (n = 5032), suburban (n = 2853), and rural areas (n = 1219) of Japan. Participants reported if they walked, cycled, drove a car, rode a car as a passenger, and used public transportation (PT) once per week or more. A standardised questionnaire was used to assess frailty status. We conducted logistic regression analysis to calculate the odds ratios of using each travel mode by frailty status stratified by locality. Relative to non-frail participants, frail participants were less likely to walk and drive a car in all three areas. Frail participants had significantly higher odds of being a car passenger in the suburban (OR = 1.73 (95% CI: 1.32, 2.25)) and rural areas (OR = 1.61 (1.10, 2.35)) but not in the metropolitan area (OR = 1.08 (0.87, 1.33)). This study found that frail older adults living in suburban and rural areas tended to rely more on cars driven by someone else, suggesting that transport disadvantage is more pronounced in suburban and rural areas than in metropolitan areas.
Collapse
|