Prehabilitation May Benefit Patients Before Heart Surgery

A new study suggests that improving the overall physical and mental status of high risk, frail patients prior to cardiac interventions could enhance the recovery process.

Researchers at the University of Manitoba (Winnipeg, Canada), St Boniface Hospital (SBGH; Winnipeg, Canada), and Western University (UWO; London, Canada) reviewed two ongoing randomized controlled trials of a 3-way approach to prehabilitation designed to improve Nutritional status, Exercise capacity, and Worry reduction. The so-called NEW approach may facilitate surgical perioperative management by ameliorating postoperative outcomes and alleviating stress-related health deconditioning.

The prehabilitation involves a combination of exercise training, education, and social support, affecting the patients' physical and psychological readiness for surgery. Prehabilitation has the overarching goal of reducing postoperative complications and hospital length of stay, as well as improving the patient’s transition from hospital to home. Enhanced Recovery Programs (ERPs) are being developed to maintain or improve overall physical and mental status of the heart patient, and reduce the impact of profound stress response following a cardiac procedure. The study was published in the July 2018 issue of the Canadian Journal of Cardiology.

“The increasing number of older adults with a heart disease and subsequent increase in demand for heart procedures represents a veritable 'silver tsunami'. Many of these patients have low physiological reserve; when they undergo cardiac surgery, they experience a disproportionate decline in their health condition, resulting in a long recovery time,” said lead author Rakesh Arora, MD, PhD, of SBGH. “In some instances, these vulnerable patients are discharged to a long-term care facility. They experience poorer postoperative outcomes and worse quality of life despite a successful heart treatment or procedure.”

“The fundamental premise behind prehab ERP is that improving patients' functional reserve before their procedure will improve postoperative outcomes that are important to older adults, including preserving mental and functional independence and enhancing postoperative recovery,” concluded Dr. Arora. “The prehab ERP depends on collaboration and engagement of the patient, their caregivers, and heart team to ensure their success.”

Related Links:
University of Manitoba
St Boniface Hospital
Western University