Cardiac surgery as a means of reversing frailty – the CURE-Frailty Trial a prospective cohort study

BACKGROUND: There is significant clinical and pathophysiological overlap between frailty and cardiovascular disease. Reversibility of frailty has previously been discussed; therefore, we hypothesised that alleviation of heart failure symptoms through cardiac surgery can reduce frailty. We aimed to examine frailty before and after cardiac surgery, as well as factors influencing frailty improvement. METHODS: We conducted a prospective observational single centre study in patients undergoing elective open or interventional cardiac surgery. Frailty was assessed using the Clinical Frailty Scale (CFS). Follow-up was performed at the time of hospital discharge, as well as 6 and 12 months postoperatively. Change in CFS between baseline and final follow-up was the primary endpoint of the study and was analysed using a paired Wilcoxon rank-sum test. Additionally, a logistic regression analysis was conducted to identify factors influencing improvement of frailty. RESULTS: Seventy-six patients were analysed in this trial. 1 year after cardiac surgery, median CFS decreased from 4 to 3 (P < 0.001). Frailty improved in 35.5%, increased in 5.2% and remained stable in 38.2% of participants. Multivariate logistic regression analysis showed a significant association between cardiac rehabilitation and improvement of frailty. CONCLUSIONS: Cardiac surgery has the potential to reverse frailty, with cardiac rehabilitation being an important factor in the postoperative improvement of frailty. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT04875923), registered on 21/04/2021.