This test could predict cognitive issues post heart surgery

A simple walking test could help predict the risk for cognitive issues in patients with heart surgery.

The distance a patient can walk in 6-minutes before a heart operation may be a clue to whether that patient will develop problems with memory, concentration, and attention after the procedure.

"This study indicates that the easy and inexpensive 6-minute walk distance (6MWD) is a valuable assessment for identifying patients at a high risk for POCD," said Kazuhiro Hayashi.

"If we are able to identify patients who are at risk for POCD, we can provide early treatment and encourage them to better understand the dysfunction."

For this study, Hayashi and colleagues identified 181 patients who were undergoing non-emergency heart surgery between March 2014 and August 2015 at Nagoya University Hospital. The mean age of the patients was 71.4 years.

Patients performed the 6MWD test upon admission for their operations. Functional exercise capacity was measured by having patients walk the length of a predetermined course at their own pace while attempting to cover as much ground as possible in 6 minutes.

The distance covered in that duration was measured to the nearest meter. According to the results of this study, a low 6MWD was an associated risk factor for POCD after cardiac surgery. In fact, the lower the 6MWD was, the more significant the reduction in cognitive function postoperatively was. Of the study participants, 51 (28 percent) developed POCD.

"It is increasingly recognized that a patient's fitness level has an impact on how well he/she does after a surgical procedure," said Rakesh C. Arora. "This study further highlights the need for the health care team to undertake a more detailed assessment of patients' physical fitness before the operation. The 6MWD is an important component of this evaluation."

According to Dr. Arora, the identification of patients at risk for POCD and other cognitive disorders should alert the health care team to consider modifying anesthetic and medication choices during-and-after the operations, as well as assist with discharge planning as patients transition to home.

In addition, the health care team should consider strategies, such as prehabilitation, to optimize the patients' fitness before their operations. Dr. Arora explained that prehabilitation includes a combination of exercise training, education, and social support intended to improve patients' physical and psychological readiness for surgery.

"Prehabilitation may be of benefit to patients with poor physical fitness by improving postoperative recovery and post-discharge functional survival," said Dr. Arora. "Patient self-management and follow-through are essential, however, as is the patient's understanding of their health issues and their proposed plan of care."

The study has been published in the journal The Annals of Thoracic Surgery.