Issue №3-21, 2022

Early Physical Rehabilitation in Frail Patients Undergoing Coronary Artery Bypass Surgery

¹ Yulia A. Argunova, ¹ Svetlana A. Pomeshkina, ¹ Olga L. Barbarash

¹ Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation

ABSTRACT

To date, there are insufficient data on the concept of exploring rehabilitation potential in older patients with frailty syndrome, while developingstrategies to improve outcomes after cardiac surgery and reducing the number of postoperative complications remains a relevant topic.Aim. To assess safety and feasibility of early physical rehabilitation in frail patients undergoing coronary artery bypass grafting (CABG).Material and methods. The study included 49 patients with stable coronary artery disease (CAD) admitted for elective CABG withcardiopulmonary bypass (CPB). Patients were randomized into two groups according to the approach to physical rehabilitation: in theearly rehabilitation group (n=22), treadmill workouts were conducted starting from the 7th postoperative day and continued at thesecond stage of inpatient rehabilitation. Patients in the control group (n=27) had no treadmill training. In the inpatient rehabilitationsetting, the incidence and the type of complications were assessed; on the 6th day and 21-23 days after CABG, the results of thecardiopulmonary exercise testing (CPET) were analyzed.Results and discussion. The groups were similar in baseline intraoperative characteristics. Postoperative complications occurred in 18%of patients in the early rehabilitation group and in 48% of patients in the control group (p=0.037). In the group of patients with earlyrehabilitation, the rate of postoperative complications decreased by 4 times compared to the control group (OR – 0.24; 95% CI – 0.06-0.896). Peak oxygen consumption (p=0.03) and exercise tolerance (p=0.03) were significantly higher in the group of patients with theearly rehabilitation according to CPET conducted three weeks after the surgery. At the present stage, it seems optimal to shift the startof physical rehabilitation in postoperative period to the earlier dates. Minimizing the patient’s immobilization period helps to optimizethe course of the postoperative period.Conclusion. Early rehabilitation in the postoperative period of CABG in patients with frailty is associated with lower incidence ofpostoperative complications and improvements in physical capacity of patients by the end of the hospital stay.

KEYWORDS: coronary artery bypass grafting, rehabilitation, physical training, initial asthenia syndrome

For citation: Argunova Yu.A., Pomeshkina S.A., Barbarash O.L. Early Physical Rehabilitation in Frail Patients Undergoing Coronary Artery Bypass Surgery. Bulletin of Rehabilitation Medicine. 2022; 21 (3): 72-80. https://doi.org/10.38025/2078-1962-2022-21-3-72-80

References:

1. Vigorito C., Abreu A., Ambrosetti M., Belardinelli R., Corrà U., Cupples M., Davos C.H., Hoefer S., Iliou MC., Schmid J.P., Voeller H., Doherty P. Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section. European Journal of Preventive Cardiology. 2017; 24(6): 577-590. https://doi.org/10.1177/2047487316682579
2. Sujino Y., Tanno J., Nakano S., Funada S., Hosoi Y., Senbonmatsu T., Nishimura S. Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction. Journal of Cardiology. 2015; 66(3): 263-268. https://doi.org/10.1016/j.jjcc.2014.12.001
3. McNallan S.M., Singh M., Chamberlain A.M., Kane R.L., Dunlay S.M., Redfield M.M., Weston S.A., Roger V.L. Frailty and healthcare utilization among patients with heart failure in the community. JACC Heart Failure. 2013; 1(2): 135-141. https://doi.org/10.1016/j.jchf.2013.01.002
4. Testa G., Liguori I., Curcio F., Russo G., Bulli G., Galizia G., Della-Morte D., Gargiulo G., Basile C., Cacciatore F., Bonaduce D., Abete P. Multidimensional frailty evaluation in elderly outpatients with chronic heart failure: A prospective study. European Journal of Preventive Cardiology. 2019; 26(10): 1115- 1117. https://doi.org/10.1177/2047487319827460
5. Kehler D.S., Giacomantonio N., Firth W., Blanchard C.M., Rockwood K., Theou O. Association Between Cardiac Rehabilitation and Frailty. The Canadian Journal of Cardiology. 2020; 36(4): 482-489. https://doi.org/10.1016/j.cjca.2019.08.032
6. Taran I.N., Argunova Yu.A., Pomeshkina S.A., Barbarash O.L. Influence of an early rehabilitation program with aerobic activity on the postoperative period in patients with coronary artery bypass grafting. Profilakticheskaya Meditsina. 2021; 24(1): 86-92. https://doi.org/10.17116/profmed20212401186 (In Russ.).
7. Taran I.N., Pomeshkina S.A., Argunova Yu.A., Barbarash O.L. Aerobic exercises are safe and effective in early rehabilitation following cardiac surgery. Complex Issues of Cardiovascular Diseases. 2020; 9(3): 30-39. https://doi.org/10.17802/2306-1278-2020-9-3-30-39 (In Russ.).
8. Doyle M.P., Indraratna P., Tardo D.T., Peeceeyen S.C., Peoples G.E. Safety and efficacy of aerobic exercise commenced early after cardiac surgery: A systematic review and meta-analysis. European Journal of Preventive Cardiology. 2019; 26(1): 36-45. https://doi.org/10.1177/2047487318798924
9. Tkacheva O.N., Kotovskaya Yu.V., Runikhina N.K., Frolova E.V., Naumov A.V., Vorobyeva N.M., Ostapenko V.S., Mkhitaryan E.A., Sharashkina N.V., Tyukhmenev E.A., Pereverzev A.P., Dudinskaya E.N. Clinical guidelines on frailty. Russian Journal of Geriatric Medicine. 2020; (1): 11-46. https://doi.org/10.37586/2686-8636-1-2020-11-46 (In Russ.).
10. Barbarash O.L., Pomeshkina S.A., Argunova Y.A. The way of postoperative physical rehabilitation of patients with coronary heart disease after coronary artery bypass surgery. Patent RU 2738571 C1, 14.12.2020. Application 2020116036 dated 27.04.2020. (In Russ.).
11. Bokeriya L.A., Aronov D.M., Barbarash O.L., Bubnova M.G., Knyazeva T.A., Lyamina N.P. Russian clinical guidelines. Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. CardioSomatics. 2016; 7(3-4): 5-71 (In Russ.).
12. Inozemtseva A.A. The use of stress test in patients after coronary artery bypass grafting to assess the effectiveness of surgery, determination of rehabilitation possibilities and prognosis. Bulletin of Siberian Medicine. 2018; 17(4): 221-228. https://doi.org/10.20538/1682-0363-2018-4-221-228 (In Russ.).
13. Kumar K.R., Pina I.L. Cardiac rehabilitation in older adults: new options. Clinical Cardiology. 2020; 43(2): 163-170. https://doi.org/10.1002/clc.23296
14. Montgomery C., Stelfox H., Norris C., Rolfson D., Meyer S., Zibdawi M., Bagshaw S. Association between preoperative frailty and outcomes among adults undergoing cardiac surgery: a prospective cohort study. CMAJ Open. 2021; 9(3): E777-E787. https://doi.org/10.9778/cmajo.20200034
15. Tamuleviciute-Prasciene E., Drulyte K., Jurenaite G., Kubilius R., Bjarnason-Wehrens B. Frailty and exercise training: how to provide best care after cardiac surgery or intervention for elder patients with valvular heart disease. BioMed Research International. 2018; (2018): 36 p. https://doi.org/10.1155/2018/9849475
16. Rossi P.G., Carnavale B.F., Farche A.C.S., Ansai J.H., de Andrade L.P., Takahashi A.C.M. Effects of physical exercise on the cognition of older adults with frailty syndrome: A systematic review and meta-analysis of randomized trials. Archives of Gerontology and Geriatrics. 2021; (93): 104322. https://doi.org/10.1016/j.archger.2020.104322
17. Ushijima A., Morita N., Hama T., Yamamoto A., Yoshimachi F., Ikari Y., Kobayashi Y. Effects of cardiac rehabilitation on physical function and exercise capacity in elderly cardiovascular patients with frailty. Journal of Cardiology. 2021; 77(4): 424-431. https://doi.org/10.1016/j.jjcc.2020.11.012
18. Buttery A.K. Cardiac rehabilitation for frail older people. Advances in Experimental Medicine and Biology. 2020; (1216): 131-147. https://doi.org/10.1007/978-3-030-33330-0_13
19. Waite I., Deshpande R., Baghai M., Massey T., Wendler O., Greenwood S. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. Journal of Cardiothoracic Surgery. 2017; 12(1): 91 p. https://doi.org/10.1186/s13019-017-0655-8

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This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.