Referral to and enrolment in cardiac rehabilitation after open-heart surgery in the Netherlands.

D Conijn,H M Vermeulen,R A F De Lind Van Wijngaarden,J J L Meesters,T P M Vliet Vlieland

doi:10.1007/s12471-021-01598-z

Abstract

AimAlthough referral to phase 2 cardiac rehabilitation (CR) following open-heart surgery is recommended in professional guidelines, according to the literature, participation rates are suboptimal. This study investigates the referral and enrolment rates, as well as determinants for these rates, for phase 2 CR following open-heart surgery via sternotomy.MethodsA cross-sectional survey study was conducted among patients who underwent open-heart surgery via sternotomy in a university hospital. Data on referral and enrolment rates and possible factors associated with these rates (age, sex, type of surgery, educational level, living status, employment, income, ethnicity) were collected by a questionnaire or from the patient’s medical file. Univariate logistic regression analysis (odds ratio) was used to study associations of patient characteristics with referral and enrolment rates.ResultsOf the 717 eligible patients, 364 (51%) completed the questionnaire. Their median age was 68 years (interquartile range 61–74) and 82 (23%) were female. Rates for referral to and enrolment in phase 2 CR were 307 (84%) and 315 (87%), respectively. Female sex and older age were independently associated with both non-referral and non-enrolment. Additional factors for non-enrolment were surgery type (coronary artery bypass grafting with valve surgery and miscellaneous types of relatively rare surgery), living alone and below-average income.ConclusionPhase 2 CR referral and enrolment rates for patients following open-heart surgery were well over 80%, suggesting adequate adherence to professional guidelines. During consultation, physicians and specialised nurses should pay more attention to certain patient groups (at risk of non-enrolment females and elderly). In addition, in-depth qualitative research to identify reasons for non-referral and/or non-enrolment is needed.

Highlights

Cardiac surgery via sternotomy, referred to as openheart surgery, is a common and effective intervention for treating heart disease, e.g. coronary heart disease, heart valve disease or aortic aneurysm [1]
A cross-sectional survey study was conducted at the Leiden University Medical Center (LUMC) in Leiden, the Netherlands
Culture concerning and attitude towards cardiac rehabilitation (CR) may vary by region or by country. This is the first study describing the rates of referral to and enrolment in phase 2 following open-heart surgery via sternotomy CR and exploring factors associated with non-referral and non-enrolment

Summary

Introduction

Cardiac surgery via sternotomy, referred to as openheart surgery, is a common and effective intervention for treating heart disease, e.g. coronary heart disease, heart valve disease or aortic aneurysm [1]. In the Netherlands, 14,937 open-heart surgeries were performed in 2017 [1]. The American College of Cardiology Foundation and the European Society of Cardiology strongly recommend cardiac rehabilitation (CR) after open-heart surgery to restore quality of life and to improve functional capacity [2,3,4,5]. In the Netherlands, CR comprises three phases. Phase 1 consists of in-hospital CR, which starts immediately after surgery and lasts until hospital discharge. Phase 2 includes outpatient CR, which usually starts 6 weeks after surgery due to consolidation of the sternum. This phase varies in duration based on severity, treatment goals and local procedures. Phase 3 is the post-CR phase, which starts after phase 2 and focusses on achieving or maintaining an active lifestyle [4]

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