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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [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.
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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
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Alfaraidhy MA, Regan C, Forman DE. Cardiac rehabilitation for older adults: current evidence and future potential. Expert Rev Cardiovasc Ther 2022; 20:13-34. [PMID: 35098848 PMCID: PMC8858649 DOI: 10.1080/14779072.2022.2035722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Growth of the older adult demographic has resulted in an increased number of older patients with cardiovascular disease (CVD) in combination with comorbid diseases and geriatric syndromes. Cardiac rehabilitation (CR) is utilized to promote recovery and improve outcomes, but remains underutilized, particularly by older adults. CR provides an opportunity to address the distinctive needs of older adults, with focus on CVD as well as geriatric domains that often dominate management and outcomes. AREAS COVERED Utility of CR for CVD in older adults as well as pertinent geriatric syndromes (e.g. multimorbidity, frailty, polypharmacy, cognitive decline, psychosocial stress, and diminished function) that affect CVD management. EXPERT OPINION Mounting data substantiate the importance of CR as part of recovery for older adults with CVD. The application of CR as a standard therapy is especially important as the combination of CVD and geriatric syndromes catalyzes functional decline and can trigger progressive clinical deterioration and dependency. While benefits of CR for older adults with CVD are already evident, further reengineering of CR is necessary to better address the needs of older candidates who may be frail, especially as remote and hybrid formats of CR are becoming more widespread.
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Affiliation(s)
- Maha A. Alfaraidhy
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,Department of Medicine, King Abdulaziz University School of Medicine, Jeddah, KSA
| | - Claire Regan
- University of Maryland School of Nursing, Baltimore, MD
| | - Daniel E. Forman
- Department of Medicine (Geriatrics and Cardiology), Section of Geriatric Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, PA,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
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Honda Y, Takahashi K, Sasanuma N, Itani Y, Nagase M, Uchiyama Y, Tamaki A, Sakaguchi T, Domen K. Predictors of Functional Decline in Activities of Daily Living at Discharge in Patients After Cardiovascular Surgery. Circ J 2021; 85:1020-1026. [PMID: 33642424 DOI: 10.1253/circj.cj-20-0909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to investigate the trajectory of functional recovery of activities of daily living (ADL) from the time of admission up to hospital discharge, and explored which preoperative and postoperative variables were independently associated with functional decline in ADL at discharge of patients after cardiovascular surgery.Methods and Results:In this observational study, we evaluated ADL preoperatively and at discharge using the Functional Independence Measure (FIM) in patients after cardiovascular surgery. Functional decline in ADL was defined as scoring 1-5 on any one of the FIM items at discharge. Multiple logistic regression was performed to predict the functional decline in ADL at discharge. We found that 18.8% of elective cardiovascular surgery patients suffered from decreased ADL at discharge. The Mini-Mental State Examination (odds ratio (OR): 0.573, 95% confidence interval (CI): 0.420-0.783), gait speed (OR: 0.032, 95% CI: 0.003-0.304) and initiation of walking around the bed (OR: 1.277, 95% CI: 1.103-1.480) were independently associated with decreased ADL at discharge. CONCLUSIONS A functional decline in ADL at discharge can be predicted using preoperative measures of cognitive function, preoperative gait speed and postoperative day of initiation of walking. These results show that preoperative cognitive screening and gait speed assessments can be used to identify patients who might require careful postoperative planning, and for whom early postoperative rehabilitation is needed to prevent serious functional ADL deficits.
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Affiliation(s)
- Yosuke Honda
- Department of Rehabilitation, Hyogo College of Medicine College Hospital
| | - Keiko Takahashi
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Naoki Sasanuma
- Department of Rehabilitation, Hyogo College of Medicine College Hospital
| | - Yusuke Itani
- Department of Rehabilitation, Hyogo College of Medicine College Hospital
| | - Masahiro Nagase
- Department of Rehabilitation, Hyogo College of Medicine College Hospital
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine
| | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences
| | | | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine
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4
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Cinotti R, Demeure-Dit-Latte D, Mahe PJ, Langlais P, Grillot N, Bouras M, Bourdiol A, Rooze P, Buffenoir K, Perrouin-Verbe B, Vibet MA, Asehnoune K, Roquilly A. Impact of a Quality Improvement Program on the Neurological Outcome of Patients with Traumatic Spinal Cord Injury: A Before-After Mono-Centric Study. J Neurotrauma 2019; 36:3338-3346. [PMID: 30907244 DOI: 10.1089/neu.2018.6298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spinal cord injury (SCI) is a major cause of severe disability. This study aims to assess the effectiveness of a quality improvement program on neurological recovery after SCI. Before-after study during two phases was done in one intensive care unit in a university hospital. The quality improvement project comprised protective mechanical ventilation, early tracheostomy in anatomical injury above the sixth cervical vertebra, early enteral nutrition, early mobilization, and active perineal care in adult SCI patients. The primary endpoint was the difference between the American Spinal Injury Association (ASIA) motor score between discharge and intensive care unit (ICU) admission (Delta ASIA). Fifty-seven and 60 patients were included in the control and in the intervention period respectively. The ASIA motor score upon ICU admission was 16 (7-37) before and 11 (2-30) after the implementation (p = 0.30). The implementation phase was associated with lower tidal volumes (p < 0.001), higher positive end-expiratory pressure (p < 0.001), earlier tracheostomy (p = 0.01), earlier enteral nutrition initiation (p < 0.05), earlier mobilization (p < 0.05), and more active perineal care (p < 0.05). The Delta ASIA was +16 [4-32] after versus +6 [0-14] before the intervention (p < 0.05). After adjustment for potential cofounders, the intervention phase was significantly associated with higher Delta ASIA (β coefficient, 11.4; CI95 [1.9-21]; p = 0.01) in multi-variable analysis. No secular time trend unrelated to the intervention was highlighted. One year after trauma, the Delta ASIA was higher in the intervention period than in the control period (+34 [15-60] vs. +11 [0-33]; p < 0.05). After adjustment on potential confounders, an early in-ICU rehabilitation program in SCI patients was associated with higher neurological score upon ICU discharge.
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Affiliation(s)
- Raphaël Cinotti
- Anesthesia and Critical Care Department, Hôpital Laennec, CHU Nantes, Nantes, France
| | | | - Pierre Joachim Mahe
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Paul Langlais
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Nicolas Grillot
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Marwan Bouras
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Alexandre Bourdiol
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Paul Rooze
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Kévin Buffenoir
- Department of Neurotraumatology, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Brigitte Perrouin-Verbe
- Physical Medicine and Rehabilitation Department, Hôpital Saint-Jacques, CHU Nantes, Nantes, France
| | - Marie-Anne Vibet
- Laboratory of Mathematics Jean Leray, University of Nantes, Nantes, France
| | - Karim Asehnoune
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France.,Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections," CHU Nantes, Nantes, France
| | - Antoine Roquilly
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France.,Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections," CHU Nantes, Nantes, France
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Furukawa H, Yamane N, Honda T, Yamasawa T, Kanaoka Y, Tanemoto K. Initial clinical evaluation of preoperative frailty in surgical patients with Stanford type A acute aortic dissection. Gen Thorac Cardiovasc Surg 2018; 67:208-213. [PMID: 30136032 DOI: 10.1007/s11748-018-0994-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND We retrospectively assessed the initial clinical role of preoperative frailty in surgical patients with Stanford type A acute aortic dissection (AAAD). METHODS One hundred and fourteen consecutive patients who underwent emergent or urgent surgical interventions for AAAD in our institute between April 2000 and March 2016 participated in this retrospective study. Patients with more than three of the following six modalities were defined as being frail: age older than 75 years, preoperative requirement of assistance in daily living, body mass index less than 18.5 kg/m2, female, history of major stroke, and chronic kidney disease greater than class 3b. Twenty-three patients (20.2%) were diagnosed with frailty (group F), while 91 patients (79.8%) were not (group N). Early clinical outcomes, major postoperative complications, postoperative recovery of activity, and early or mid-term survival were evaluated. RESULTS Although early clinical outcomes and the prevalence of major postoperative complications were similar in both groups, postoperative activity of daily living (ADL), such as the rate of being ambulatory on discharge (p < 0.05) and home discharge (p < 0.01), was significantly lower in group F than in group N. A Kaplan-Meier analysis revealed that 1- and 5-year survival rates were similar in groups F (85.9 and 76.4%, respectively) and N (86.0 and 76.9%, respectively). CONCLUSIONS Preoperative frailty in AAAD surgical patients has potential as a prognostic factor that affects delays in ADL recovery, but does not influence the early or mid-term clinical outcomes of prompt surgical strategies for life rescue in AAAD patients with frailty.
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Affiliation(s)
- Hiroshi Furukawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Naoki Yamane
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Takeshi Honda
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Takahiko Yamasawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Yuji Kanaoka
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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Tobita R, Iwata K, Kamisaka K, Yuguchi S, Tahara M, Oura K, Morisawa T, Ohhashi S, Kumamaru M, Hanafusa Y, Kato M, Saitoh M, Sakurada K, Takahashi T. Clinical characteristics of functional recovery after coronary artery bypass graft surgery in Japanese octogenarians. J Phys Ther Sci 2016; 28:621-5. [PMID: 27065553 PMCID: PMC4793021 DOI: 10.1589/jpts.28.621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/17/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to elucidate characteristics of postoperative physical
functional recovery in octogenarians undergoing coronary artery bypass graft surgery.
[Subjects and Methods] This was a multi-center, retrospective study. Nine hundred and
twenty-seven elective isolated coronary artery bypass graft surgeries were evaluated (746
males and 181 females, mean age: 68.6 years, range: 31–86 years). Participants were
stratified according to age < 80 years (n = 840; mean age, 67.1; range, 31–79) or >
80 years (n = 87; mean age, 82.2; range, 80–86). Patient characteristics and postoperative
physical functional recovery outcomes were compared between groups. [Results] There was no
significant difference between groups when considering the postoperative day at which
patients could sit on the edge of the bed, stand at bedside, or walk around the bed. The
postoperative day at which patients could walk 100 m independently was later in
octogenarians, when compared with non-octogenarians (6.1 ± 3.2 days vs. 4.9 ± 3.9 days).
In octogenarians, the percentage of patients who could walk 100 m independently within 8
days after surgery was 79.5%. [Conclusion] A postoperative target time in octogenarians
for independent walking, following coronary artery bypass grafting, can be set at
approximately 6 days.
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Affiliation(s)
- Ryo Tobita
- Department of Rehabilitation, Shiga University of Medical Science Hospital, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Japan
| | - Kenta Kamisaka
- Rehabilitation Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Satoshi Yuguchi
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Japan
| | - Masayuki Tahara
- Department of Rehabilitation, Higashi Takarazuka Satoh Hospital, Japan
| | - Keisuke Oura
- Division of Rehabilitation, Fukuyama Cardiovascular Hospital, Japan
| | - Tomoyuki Morisawa
- Department of Physical therapy, Faculty of Rehabilitation, Hyogo University of Health Sciences, Japan
| | - Satoko Ohhashi
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Japan
| | - Megumi Kumamaru
- Department of Rehabilitation, Gunma Children's Medical Center, Japan
| | - Yusuke Hanafusa
- Department of Rehabilitation, Saitama Medical University International Medical Center, Japan
| | - Michitaka Kato
- Department of Rehabilitation, Shizuoka Medical Center, Japan
| | - Masakazu Saitoh
- Department of Physiotherapy, Sakakibara Heart Institute, Japan
| | - Koji Sakurada
- Department of Rehabilitation, The Cardiovascular Institute, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, School of Health Science, Tokyo University of Technology, Japan
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Cordeiro AL, Melo TAD, Santos AM, Lopes GF. Time influence of mechanical ventilation on functional independence in patients submitted to cardiac surgery: literature review. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.004.ar04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Patients submitted to cardiovascular surgery present motor and respiratory complications mainly due to high surgery manipulation and the use of mechanical ventilation. Reducing the weaning start time and disconnecting patient's ventilation system prematurely can decrease the pulmonary complications and hospitalization time. Motor complications are the most relevant as they have a direct effect on functional independence provoked by immobility time. Objectives : Identify if mechanical ventilation time has an impact on functional capacity on patients submitted to cardiac surgery in order to contribute to the establishment of reliable evidence to practice through this patient's profile. Materials and methods : Original articles were analyzed, published between 2000 and 2014, which focused on the influence of mechanical ventilation time concerning the functional independence on patients submitted to cardiac surgery, contained in the following electronic database: Scielo, BIREME (LILACS), PubMed e CAPES. Results : It was observed that the length of stay in the intensive care unit in cardiac surgery was influenced directly by CPB, VM and pulmonary dysfunction. Functional independence was compromised in patients with longer duration of mechanical ventilation, postoperative pain and prolonged bed rest. It was also found that there is no consensus on the protocol for improved functional capacity. Conclusion : There is a functional decline in patients undergoing cardiac surgery, especially those at increased length of stay in mechanical ventilation, reflecting a direct and negative impact on their functional independence and quality of life.
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Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part I: Routine Postoperative Care. Crit Care Med 2015; 43:1477-97. [PMID: 25962078 DOI: 10.1097/ccm.0000000000001059] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Cardiac surgery, including coronary artery bypass, cardiac valve, and aortic procedures, is among the most common surgical procedures performed in the United States. Successful outcomes after cardiac surgery depend on optimum postoperative critical care. The cardiac intensivist must have a comprehensive understanding of cardiopulmonary physiology and the sequelae of cardiopulmonary bypass. In this concise review, targeted at intensivists and surgeons, we discuss the routine management of the postoperative cardiac surgical patient. DATA SOURCE AND SYNTHESIS Narrative review of relevant English-language peer-reviewed medical literature. CONCLUSIONS Critical care of the cardiac surgical patient is a complex and dynamic endeavor. Adequate fluid resuscitation, appropriate inotropic support, attention to rewarming, and ventilator management are key components. Patient safety is enhanced by experienced personnel, a structured handover between the operating room and ICU teams, and appropriate transfusion strategies.
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9
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Frailty in cardiothoracic surgery: systematic review of the literature. Gen Thorac Cardiovasc Surg 2015; 63:425-33. [PMID: 25916404 DOI: 10.1007/s11748-015-0553-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/18/2015] [Indexed: 12/21/2022]
Abstract
A preoperative surgical risk analysis is necessary and important for predicting clinical and surgical outcomes in a clinical setting. Various tools for evaluating the patient characteristics in order to forecast perioperative clinical outcomes have previously been described; however, an objective and precise preoperative risk assessment has not yet been established. In the last decade, the concept of frailty, which is a geriatric assessment that identifies disabilities and weaknesses in patients, has been used in order to predict clinical mortality and morbidity following invasive surgical interventions because the prevalence of elderly patients among those undergoing surgical interventions is increasing. Since there is currently no single generally accepted clinical definition of frailty, many clinical modalities are needed to evaluate the patients' geriatric activity of daily living. Quantifying the quality of frailty is an evolving challenge for predicting surgical risks preoperatively. In recent years, with the development of transcatheter aortic valve implantation (TAVI), this newly definitive preoperative surgical risk assessment tool, frailty, has become more important and is attracting interest in cardiothoracic surgical settings. Thus, this review summarized current consideration on the preoperative risk analysis by frailty as well as future perspectives and the potential of an ideal frailty risk assessment in cardiothoracic surgery, including the management of elderly patients and high-risk aortic valve stenosis by TAVI.
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Abstract
Open-heart surgery has become a common procedure. Postcardiac surgery management is a critical issue and represents a crucial period in terms of physical recovery. Cardiac rehabilitation is increasingly considered as an integral component of the continuum of care for patients with cardiovascular disease. Its usefulness is now widely accepted, and therefore, it is recommended in most contemporary cardiovascular clinical practice guidelines. Similarly, early pharmacological management can modulate the pathophysiological alterations after cardiac surgery, leading to an improvement in the early and long-term outcome. In this review, we will present recent advances in postcardiac surgery management, focusing on the pathophysiology of the perioperative period and on recent evidences in pharmacological and rehabilitative strategies.
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Goldstein DJ, Bello R, Shin JJ, Stevens G, Zolty R, Maybaum S, D'Alessandro D. Outcomes of cardiac transplantation in septuagenarians. J Heart Lung Transplant 2012; 31:679-85. [DOI: 10.1016/j.healun.2012.03.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/06/2012] [Accepted: 03/27/2012] [Indexed: 11/28/2022] Open
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Martínez-Velilla N, Alonso Bouzón C, Ripa Zazpe C, Sánchez-Ostiz R. [Acute postoperative confusional syndrome in the elderly patient]. Cir Esp 2011; 90:75-84. [PMID: 22176651 DOI: 10.1016/j.ciresp.2011.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 09/05/2011] [Accepted: 09/06/2011] [Indexed: 11/15/2022]
Abstract
With the progressive aging of the population surgical candidates have more comorbidities resulting in a higher risk to develop postoperative complications. One of the most frequent postoperative complications in the elderly is acute confusional state or delirium, which may have devastating consequences: higher mortality, and risk of medical complications during admission and, a higher risk of functional decline, institutionalization, and cognitive impairment at discharge. For all these reasons and with the aim of optimising surgical procedures, it is essential to identify patients at risk of delirium in order to take appropriate preventive action and provide early treatment. In the present article we review the current evidence on the management of postoperative delirium in the elderly.
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Mächler H, Salaymeh L, Zirngast B, Anelli-Monti M, Oberwalder P, Yates A, Knez I, Huber S, Streinu C, Ovcina I, Malliga D, Keeling I, Beran E, Mircic A, Meszaros K, Hetterle R, Rieger K, Curcic P, Vötsch A, Marte W, Toller W, Quehenberger F, Dacar D. There is no significant difference in the operative risk between octogenarians compared with patients younger than 60 years in cardiac surgery*. Eur Surg 2011. [DOI: 10.1007/s10353-011-0054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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