Five-year Hospitalisations and Survival in Patients Admitted to Inpatient Cardiac Rehabilitation After Cardiac Surgery

Background: The effect of an early comprehensive rehabilitation programme on the evolution of disability after cardiac surgery and the long-term effect of the residual functional status has not yet been investigated.

Aim: To analyse the recovery from disability after cardiac surgery and to assess the impact of residual disability on long-term outcomes.

Methods: Data prospectively recorded from 5261 patients, consecutively admitted to an inpatient rehabilitation programme after cardiac surgery, were retrospectively analysed. Disability was assessed twice, on admission (to evaluate the post-surgery disability) and at discharge (to evaluate the recovery after rehabilitation). Study cohort survival at 5-year follow-up was also compared with that of a reference population matched for age and sex.

Results: On admission, severe, moderate, mild or no disability was documented in 18.2%, 29.4%, 39.8% and 12.5% of patients, respectively. After rehabilitation, 75.1% of patients with severe disability improved their functional status, with an associated 50% reduction in mortality at 5-year follow-up. The Barthel index was the major predictor of survival and hospitalisations at follow-up. Comparison of the observed versus expected survival showed a worse outcome in patients with persistent moderate to severe residual disability.

Conclusions: The reduction in all-cause mortality at follow-up documented in those patients with severe disability post-surgery who improved after rehabilitation underscores the effectiveness of a comprehensive inpatient cardiac rehabilitation programme and should encourage a more widespread use of rehabilitation early after an acute cardiac event.