Cardiac rehabilitation after cardiac surgery: An important underutilized treatment strategy

Abstract

Physical inactivity remains in high levels after cardiac surgery, reaching up to 50%. Patients present a significant loss of functional capacity, with prominent muscle weakness after cardiac surgery due to anesthesia, surgical incision, duration of cardiopulmonary bypass, and mechanical ventilation that affects their quality of life. These complications, along with pulmonary complications after surgery, lead to extended intensive care unit (ICU) and hospital length of stay and significant mortality rates. Despite the well-known beneficial effects of cardiac rehabilitation, this treatment strategy still remains broadly underutilized in patients after cardiac surgery. Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength. Early mobilization should be adjusted to each patient’s functional capacity with progressive exercise training, from passive mobilization to more active range of motion and resistance exercises. Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity. During the last decade, recent advances in healthcare technology have changed cardiac rehabilitation perspectives, leading to the future of cardiac rehabilitation. By incorporating artificial intelligence, simulation, telemedicine and virtual cardiac rehabilitation, cardiac surgery patients may improve adherence and compliance, targeting to reduced hospital readmissions and decreased healthcare costs.

Keywords: Cardiac rehabilitation; Cardiac surgery; Cardiopulmonary exercise testing; Early mobilization; Treatment; Technology

Core Tip: Cardiac rehabilitation is a medically supervised program designed to maintain or improve cardiovascular health, and should be considered as an important treatment strategy in patients after cardiac surgery. It has multiple beneficial effects on functional capacity, endothelial and skeletal muscle function, and quality of life. Recent advances have been made in cardiac rehabilitation during the last decades, including the use of artificial intelligence, simulation, telemedicine and virtual cardiac rehabilitation that improve compliance. As a result, reduced hospital readmissions and decreased healthcare costs are being observed in the modern healthcare systems.