How helpful is prehabilitation before heart surgery

Washington: Older and frail patients could benefit from prehabilitation before surgery, finds a study.

Prehabilitation is the process of enhancing an individual's functional capacity to enable him or her to withstand a forthcoming stressor. The demand for surgical services is increasing as a result of an expanding "ageing population."

"The increasing number of older adults with a heart disease and subsequent increase in demand for heart procedures represents a veritable 'silver tsunami'," explained lead investigator Dr Rakesh C. Arora. "Many of these patients have a low physiological reserve. So when they undergo cardiac surgery, they experience a disproportionate decline in their health condition resulting in a long recovery time. In some instances, these vulnerable patients are discharged to a long-term care facility. In such cases, they experience poorer postoperative outcomes and worse quality of life despite a successful heart treatment or procedure," he added.

"There is, therefore, an urgent need for the heart care team to ensure that the patients are not only liberated of cardiac disease symptoms, but also experience a better postoperative health-related quality of life, so they don't just survive, but thrive after their procedure," noted Dr Arora.

There is some evidence to support the effectiveness of "prehabilitation" (prehab), a combination of exercise training, education, and social support, affecting patients' physical and psychological readiness for surgery, but these types of programs are not widespread. Prehab has the overarching goal to reduce postoperative complications and hospital length of stay as well as ideally improving the transition from the hospital back home. However, there is no formal consensus regarding what this should involve.

While prehab has been used in patients undergoing bowel or bone surgery, it has not been widely considered for heart patients before surgery. Dr Arora and colleagues describe how new treatment protocols, also known as Enhanced Recovery Programs (ERPs), can help the heart team decide on the best treatment plan for vulnerable older adult patients before their procedures.

The goals of an ERP are to maintain or improve the overall physical and mental status of the heart patient and reduce the impact of profound stress response following a cardiac procedure. They analysed evidence from previous trials to support the use of prehab and evaluated how the NEW approach, a three-way approach including nutrition optimisation, exercise training, and anxiety (worry) reduction (nutrition, exercise, and worry = NEW) may benefit heart patients.

Part of the barrier to the use of prehab in cardiac patients is the need for well done, multicenter, prospective studies. "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," noted Dr Arora. "The prehab ERP depends on collaboration and engagement of the patient, their caregivers, and heart team to ensure their success," he added.

The findings appear in the Canadian Journal of Cardiology.