Abstract
Background
Hospital-acquired functional decline (HAFD) is a new predictor of poor prognosis in hospitalized older patients.
Aims
We aimed to assess the impact of HAFD on the prognosis of older cardiac surgical patients 2 years after discharge.
Methods
This multicenter prospective cohort study assessed 293 patients with cardiac disease aged ≥ 65 years who underwent cardiac surgery at 7 Japanese hospitals between June 2017 and June 2018. The primary endpoint was the composite outcome of cardiovascular-related readmission and all-cause mortality 2 years after discharge. HAFD was assessed using the total Short Physical Performance Battery at hospital discharge.
Results
The primary outcome was observed in 17.3% of the 254 included patients, and HAFD was significantly associated with the primary outcome. Female sex (hazard ratio [HR], 2.451; 95% confidence interval [CI] 1.232–4.878; P = 0.011), hemoglobin level (HR, 0.839; 95% CI 0.705–0.997; P = 0.046), preoperative frailty (HR, 2.391; 95% CI 1.029–5.556; P = 0.043), and HAFD (HR, 2.589; 95% CI 1.122–5.976; P = 0.026) were independently associated with the primary outcome. The incidence rate of HAFD was 22%, with female sex (odds ratio [OR], 1.912; 95% CI 1.049–3.485; P = 0.034), chronic obstructive pulmonary disease (OR, 3.958; 95% CI 1.413–11.086; P = 0.009), and the time interval (days) between surgery and the start of ambulation (OR, 1.260, 95% CI 1.057–1.502; P = 0.010) identified as significant factors.
Discussion
HAFD was found to be an independent prognostic determinant of the primary outcome 2 years after discharge.
Conclusion
HAFD prevention should be prioritized in the hospital care of older cardiac surgery patients.
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Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We would like to thank all the staff members in all the included hospitals, institutes, and universities. This multicentered study was carried out at the Sakakibara Heart Institute of Okayama, Tsuchiya General Hospital, Higashi Takarazuka Satoh Hospital, Tomishiro Central Hospital, Fukuyama Cardiovascular Hospital, Kansai Electronic Power Hospital, Kobe City Medical Center General Hospital, The Cardiovascular Institute, and Juntendo University.
Funding
This work was supported by Japan Society for the Promotion of Science KAKENHI (grant number: 17K01544).
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Conceptualization: TM, MS, TT; data curation: SO, GT, MT, YO, YT, KI, KO; formal analysis: TM, MS; funding acquisition: TM, TT; investigation: TM, SO, GT, MT, YO, YT, KI, KO; methodology: TM, MS, KS, TT; project administration: TM, TT; resources: TM, MS; software: TM, MS; supervision: TT; validation: TM, MS; visualization: TM, MS; writing—original draft: TM, MS, TT; writing—review and editing: all authors.
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This study was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments and was approved by the ethics committees of Faculty of Health Science of Juntendo University (19-003). Written informed consent was obtained from all patients.
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Morisawa, T., Saitoh, M., Otsuka, S. et al. Association between hospital-acquired functional decline and 2-year readmission or mortality after cardiac surgery in older patients: a multicenter, prospective cohort study. Aging Clin Exp Res 35, 649–657 (2023). https://doi.org/10.1007/s40520-022-02335-1
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DOI: https://doi.org/10.1007/s40520-022-02335-1