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Cardiac Rehabilitation After Heart Valve Surgery: IMPROVEMENT IN EXERCISE CAPACITY AND MORBIDITY

Pollmann, Agathe Gerwina Elena MS; Frederiksen, Marianne MD, DMSc; Prescott, Eva MD, DMSc

Journal of Cardiopulmonary Rehabilitation & Prevention: May 2017 - Volume 37 - Issue 3 - p 191–198
doi: 10.1097/HCR.0000000000000208
Cardiac Rehabilitation

PURPOSE: Evidence of the effect of cardiac rehabilitation (CR) after heart valve surgery is scarce, but nevertheless CR is recommended for this group of patients. Therefore, this study assessed the effect of CR on exercise capacity, cardiovascular risk factors, and long-term mortality and morbidity, as well as predictors for enrolment in or failing to complete CR.

METHODS: A review of medical records identified 250 patients who underwent heart valve surgery between January 2009 and August 2013. Of these, 211 patients eligible for CR were identified. Effect of CR was assessed by peak oxygen uptake (

O2peak) or 6-minute walk test (6MWT). A composite endpoint of all-cause mortality and hospital admission due to myocardial infarction, stroke, heart failure, endocarditis, revascularization, or reoperation was used to assess the hazard ratio between CR attenders and nonattenders. Multivariable logistic regression was used to find predictors for CR attendance and CR completion.

RESULTS: A total of 146 patients completed CR.

O2peak improved by 16% from 21.6 to 24.8 mL/kg/min (P < .0001) and 6MWT distance by 13% from 349 to 393 m (P = .0016). Rate of clinical events was higher among nonattenders with an adjusted hazard ratio of 2.46 (95% CI, 1.26-4.80). Age >75 years was predictive for not attending (adjusted OR, 2.99; 95% CI, .37-6.53), whereas ethnic minorities were less likely to complete CR (adjusted OR, 4.88; 95% CI, 1.58-15.06).

CONCLUSIONS: CR after heart valve surgery improved exercise capacity and was associated with reduced morbidity. Elderly and ethnic minorities were less likely to attend or complete CR and deserve special attention.

This study assessed the effect of cardiac rehabilitation on exercise capacity, cardiovascular risk factors, and long-term morbidity. Participation in cardiac rehabilitation was associated with improved exercise capacity and reduced long-term morbidity. Elderly and ethnic minorities were less likely to attend or complete cardiac rehabilitation.

Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.

Correspondence: Eva Prescott, MD, DMSc, Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Bldg 67, 1st Floor, DK-2400, Copenhagen, Denmark (Eva.Irene.Bossano.Prescott@regionh.dk).

All authors have read and approved the article.

The authors declare no conflicts of interest.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.