Health

Cardiac rehab after heart valve surgery tied to better outcomes

(Reuters Health) – Cardiac rehab, known to be helpful after heart attacks, may also aid recovery from heart valve surgery, a study suggests.

Older adults who got cardiac rehabilitation after heart valve surgery were less likely to be hospitalized or die over the next year than those who didn’t get this support, the study found.

Researchers examined data on 41,369 people insured by Medicare, the U.S. health program for individuals 65 and older, who had valve surgery in 2014. Overall, only 43% of them enrolled in medically-supervised cardiac rehab programs focused on things like stress reduction, exercise and heart-healthy living.

Compared to people who didn’t go to cardiac rehab, those who did were 34% less likely to be hospitalized within one year of discharge after valve surgery, the study found. And rehab patients were also 61% less likely to die within one year of discharge.

“To our knowledge, this is the first study to evaluate cardiac rehabilitation (CR) utilization among patients undergoing cardiac valve surgery at the national level in the United States,” said Dr. Justin Bachmann, senior author of the study and medical director of the cardiopulmonary rehabilitation program at Vanderbilt University Medical Center in Nashville, Tennessee.

Cardiac rehab has previously been found effective for patients recovering from other types of procedures after heart attacks or procedures to place stents to prop open arteries, researchers note in JAMA Cardiology.

“Cardiac rehab includes supervised exercise as well as dietary and smoking cessation counseling,” Bachmann said by email. “Management of cardiovascular risk factors (i.e. diet and stopping smoking) as well as improvements in cardiorespiratory fitness translate into improved health.”

But not all patients in the study had equal access to cardiac rehab.

Compared to white patients, Asian and Hispanic patients were 64% less likely to get cardiac rehab, while black patients had 40% lower odds.

At the same time, people who had coronary artery bypass grafting in addition to valve surgery were 26% more likely to get cardiac rehab than those who only had valve procedures.

And people living in the Midwest were more than twice as likely to go to cardiac rehab as patients living in southern states.

Half of the patients in the study were at least 73 years old.

One-year mortality rates, excluding people who died while hospitalized for the valve surgery or within 30 days of discharge, were 6.6% overall. Among patients who got cardiac rehab, one-year mortality was 2.2%

The study wasn’t designed to prove whether or how cardiac rehab might directly affect patient outcomes, nor did it examine why some patients might not have been offered cardiac rehab or chose not to enroll.

Even so, the results underscore the importance of discussing options for cardiac rehab, when possible before surgery so services will be lined up when they’re needed, said Dr. Randal Thomas, co-author of an editorial accompanying the study and medical director of cardiac rehabilitation at the Mayo Clinic in Rochester, Minnesota.

“They will recover quicker, feel better, function better, and live longer as a result,” Randal said by email. “If a center-based program is not available near them, they should ask about the options for a home-based cardiac rehabilitation program that would be available to them instead.”

SOURCE: bit.ly/2N5YYlT and bit.ly/2r1xYeN JAMA Cardiology, online October 23, 2019.


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