Frailty of elderly patients with cardiac disease undergoing inpatient cardiological rehabilitation

Background: The prevalence of sarcopenia and its impact on older adults undergoing inpatient cardiac rehabilitation after cardiac surgery are poorly understood.

Aim: To determine the level of sarcopenia and quantify the functional capacity of older patients with and without sarcopenia participating in a cardiac rehabilitation program.

Materials and methods: A sample of 122 patients over 75 years of age undergoing cardiac rehabilitation after cardiac surgery at the Voronezh Regional Clinical Hospital No. 1 was followed up for 3 months. The SARC-F questionnaire, which included questions on strength, assistance with mobility, getting up from a chair, climbing stairs, and falls, was used for the initial identification of patients with sarcopenia. The Katz index, Clinical Frailty Scale (CFS), Hand Grip Strength (HGS), Short Physical Performance Battery (SPPB), and 6-minute walking distance (6MWD) were also assessed to determine functional capacity and weakness at the initial stage. The primary outcomes were the prevalence of sarcopenia and its correlation with functional capacity and frailty at baseline, including the SARC-F score at follow-up. The Wilcoxon signed-rank test was used to compare before and after. Correlations between sarcopenia and 6MWD, SPPB and HGS were examined using the correlation coefficient and one-way analysis of variance.

Results: Complete data were collected from 101 patients (79.9±4.0 years; 63% men). At baseline, the mean SARC-F score was 2.7±2.1, with 35% of participants having sarcopenia. Other baseline parameters were: Kots index 5.7±0.9, CFS 3.2±1.4, HGS 24.9±9.9 kg, SPPB score 7.5±3.3, and 6MWD 288.8±136.5 m. Compared with baseline data, the proportion of patients with sarcopenia at follow-up decreased (23% vs. 35%). In the group of patients with sarcopenia at baseline (n=35), comparison of before and after data showed a statistically significant improvement in SARC-F (p=0.017). A significant correlation was also found between sarcopenia, as determined using SARC-F, and low functional assessment scores (p <0.001; r >0.546).

Conclusions: The incidence of sarcopenia in elderly patients in the interposition coronary resuscitation unit after cardiac surgery is quite high (35%) and remains high during follow-up (23%). Screening for sarcopenia is key, as its diagnosis in these patients is strongly associated with deterioration in functional performance. These studies indicate that these patients may benefit significantly from pre-planned rehabilitation aimed at improving postoperative outcomes, increasing functional activity, and reducing adverse effects.