Twelve-month follow-up effects of cognitive training after heart valve surgery on cognitive functions and health-related quality of life: a randomised clinical trial

Marius Butz; Tibo Gerriets; Gebhard Sammer; Jasmin El-Shazly; Marlene Tschernatsch; Tobias Braun; Rolf Meyer; Patrick Schramm; Thorsten R Doeppner; Andreas Böning; Thomas Mengden; Yeong-Hoon Choi; Markus Schönburg; Martin Juenemann

doi:10.1136/openhrt-2023-002411

Twelve-month follow-up effects of cognitive training after heart valve surgery on cognitive functions and health-related quality of life: a randomised clinical trial

Open Heart. 2023 Nov 27;10(2):e002411. doi: 10.1136/openhrt-2023-002411.

Authors

Marius Butz^{1

2}, Tibo Gerriets^{3

2}, Gebhard Sammer^{3

4}, Jasmin El-Shazly⁵, Marlene Tschernatsch^{3

2}, Tobias Braun^{3

2}, Rolf Meyer³, Patrick Schramm^{3

2}, Thorsten R Doeppner², Andreas Böning⁶, Thomas Mengden⁷, Yeong-Hoon Choi⁸, Markus Schönburg^{3

8}, Martin Juenemann^{3

2}

Affiliations

¹ Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany m.butz@kerckhoff-klinik.de.
² Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany.
³ Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany.
⁴ Department of Psychology, University of Giessen, Giessen, Germany.
⁵ Department of Psychocardiology, Kerckhoff Clinic, Bad Nauheim, Germany.
⁶ Department of Cardiovascular Surgery, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany.
⁷ Department of Rehabilitation, Kerckhoff Clinic, Bad Nauheim, Germany.
⁸ Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany.

Abstract

Objectives: Postoperative cognitive decline (POCD) or decreased health-related quality of life (HQL) have been reported after cardiac surgery. A previous investigation showed beneficial effects of postoperative cognitive training on POCD and HQL 3 months after heart surgery. Here, we present the 12-month follow-up results.

Methods: This bicentric, 1:1 randomised and treatment-as-usual controlled trial included elderly patients scheduled for elective heart valve surgery. The training consisted of paper-and-pencil-based exercises practising multiple cognitive functions for 36 min/day 6 days/week over a period of 3 weeks. Neuropsychological tests and questionnaires assessing HQL (36-Item Short Form Health Survey (SF-36)) and cognitive failures in daily living (Cognitive Failures Questionnaire) were performed presurgery and 12 months after training.

Results: Twelve months post training, the training group (n=30) showed improvements in HQL compared with the control group (n=28), especially in role limitations due to physical health (U=-2.447, p=0.015, η²=0.109), role limitations due to emotional problems (U=-2.245, p=0.025, η²=0.092), pain (U=-1.979, p=0.049, η²=0.068), average of all SF-36 factors (U=-3.237, p<0.001, η²=0.181), health change from the past year to the present time (U=-2.091, p=0.037, η²=0.075), physical component summary (U=-2.803, p=0.005, η²=0.138), and mental component summary (U=-2.350, p=0.018, η²=0.095). Furthermore, the training group (n=19) showed an improvement compared with the control group (n=27) in visual recognition memory (U=-2.137, p=0.034, η²=0.099). POCD frequency was 22% (n=6) in the control group and 11% (n=2) in the training group (χ²(1) =1.06, p=0.440; OR=2.43, 95% CI 0.43 to 13.61).

Conclusion: In conclusion, postoperative cognitive training shows enhancing effects on HQL in cardiac surgery patients after 12 months.

Keywords: CARDIAC SURGERY; Cardiac Rehabilitation; Coronary Artery Bypass; Heart Valve Prosthesis Implantation.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Cardiac Surgical Procedures* / adverse effects
Cognition
Cognitive Training
Follow-Up Studies
Heart Valves / surgery
Humans
Postoperative Cognitive Complications*
Quality of Life