Predicting functional decline in older patients undergoing cardiac surgery.

BACKGROUND: a growing number of older patients undergo cardiac surgery. Some of these patients are at increased risk of post-operative functional decline, potentially leading to reduced quality of life and autonomy, and other negative health outcomes. First step in prevention is to identify patients at risk of functional decline. There are no current published tools available to predict functional decline following cardiac surgery.

OBJECTIVE: to validate the identification of seniors at risk-hospitalised patients (ISAR-HP), in older patients undergoing cardiac surgery.

DESIGN AND METHODS: a multicenter cohort study in cardiac surgery wards of two university hospitals with follow-up 3 months after hospital admission.

INCLUSION CRITERIA: consecutive cardiac surgery patients, aged ≥65. Functional decline was defined as a decline of at least one point on the Katz ADL Index at follow-up compared with preadmission status.

RESULTS: 475 patients were included, 16% of all patients and 20% of patients ≥70+ suffered functional decline. The amended prediction model predicted functional decline using four criteria: preadmission need for daily assistance in instrumental activities of daily living, use of a walking device, need for assistance in travelling and no education after age 14. Area under the receiver operating curve for patients ≥70 it was 0.73. For the amended ISAR-HP sensitivity, specificity, positive and negative predictive values were 85, 48, 29 and 93%, respectively.

CONCLUSIONS: the amended ISAR-HP used in older cardiac surgery patients showed good discriminative values at score ≥1, supporting the generalisability of this prediction model for this patient group.