Five-year hospitalisations and survival in patients admitted to inpatient cardiac rehabilitation after cardiac surgery.

Abstract

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