DOI: 10.1111/ggi.70885 ISSN: 1444-1586

Longitudinal Trajectories and Determinants of Post‐Discharge Frailty in Older Adults Undergoing Cardiac Surgery: A 2‐Year Cohort Study

Kazuhisa Tsurumoto, Kenta Kamisaka, Kentaro Iwata, Masami Inokuma, Go Takamura, Akira Minei, Yusuke Ochi, Koji Sakurada, Yu Hojo, Junichi Nishikawa, Masayuki Tahara, Yosuke Takahashi, Satomi Kusaka, Masakazu Saitoh, Tomoyuki Morisawa, Tetsuya Takahashi
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ABSTRACT

Aims

To elucidate longitudinal changes in frailty and identify factors associated with its improvement or progression in patients undergoing cardiac surgery.

Methods

This multicenter prospective cohort study used data from the Japanese Cardiovascular Physiotherapy Network registry. Patients aged 65–89 years who underwent elective cardiac surgeries between May 2021 and December 2022 were included. Frailty was assessed using the Kihon Checklist ( KCL ) preoperatively and at 6, 12, and 24 months after discharge. Group‐based trajectory modeling identified distinct frailty trajectories over 2 years. Multinomial logistic regression examined factors associated with trajectory group membership. Longitudinal changes in KCL scores were evaluated using linear mixed‐effects models.

Results

Among 588 patients (mean age, 74.7 years; 41.0% female), three trajectories were identified. Group 1 (50.5%) showed persistently low and improving KCL scores, indicating favorable recovery. Group 2 (36.1%) exhibited moderate and stable frailty. Group 3 (13.3%) demonstrated persistently high and progressively worsening frailty. Compared with Group 1, membership in Group 3 was significantly associated with postoperative delirium, chronic obstructive pulmonary disease, lower hemoglobin levels, lower Barthel index scores, more advanced age, lower body mass index, reduced left ventricular ejection fraction, and impaired renal function. Linear mixed‐effects modeling confirmed a significant group‐by‐time interaction ( p  < 0.001), with sustained frailty increases occurring only in Group 3.

Conclusions

Frailty trajectories following cardiac surgery are heterogeneous; approximately one in eight patients experience persistent and progressive frailty over the first 2 postoperative years. Early identification of high‐risk patients may enable targeted multidisciplinary interventions to improve long‐term functional outcomes.

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