Predicting the Functional Status of Post-Cardiac Surgery Patients at Six Months After Discharge from Hospital : Utilizing the 6-Minute Walk Test Distance (6-MWT) and Clinical Characteristics at Hatyai Hospital
Keywords:
prognostic prediction, 6-minute walk test, cardiac rehabilitation, post-cardiac surgeryAbstract
Objectives: To evaluate the use of the 6-minute walk test (6-MWT) in predicting the functional status of post-cardiac surgery patients six months after discharge
Study design: Prognostic prediction research and retrospective observational cohort design
Setting: Hatyai Hospital, Thailand
Subjects: Post-cardiac surgery pateints at six months after discharge from Hatyai Hospital
Methods: The study retrospectively reviewed pre- and post-cardiac surgery data records. Patients’ functional status at six months was assessed using the New York Heart Association (NYHA) Classification. Multivariable logistic regression analysis was employed to identify variables to predict the patients’ functional status. The predictive scores were assigned based on coefficient values derived from the regression equation.
Results: A total of 272 post-cardiac surgery patients were followed up six months after discharge, of whom 181 patients (66.5%) exhibited good functional status (NYHA Classification 1). Six variables were predictive of NYHA Classification 1: pre-surgery ejection fraction (EF), length of hospital stay (LOS), metabolic equivalences (METs) pre-discharge, duration of daily exercise at two weeks, duration of daily exercise at six weeks, and the six-minute walk test (6-MWT) at three months. The constructed prediction scores ranged from 0 to 23. The prediction score performed well in predicting the functional status at six months with an area under the receiver operating characteristic curve (AUROC) 0.89, 95%CI: 0.85-0.93. The clinical risk scores were categorized into two groups: low-good functional status scores (< 14) with a positive predictive value (PPV) of 37.5 (95%CI: 20-40, p < 0.001) and high-good functional status scores (≥ 14) with a PPV of 95.6 (95%CI: 0.91-0.98, p < 0.001).
Conclusions: The combination of pre-surgery EF, METs pre-discharge, LOS, duration of daily exercise at two weeks and six weeks, and the 6-MWT distance at three months can serve as a predictor of the good functional status of post-cardiac surgery patients at six months after discharge.
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