title: [Major epidemiological changes and clinical variables in patients undergoing a program of heart rehabilitation after cardiac surgery - MEPHISTOPHELES].
abstract: BACKGROUND
  Recent observational studies show an increase of more complex and critically ill patients referred to Italian cardiac rehabilitation (CR) departments; the exact mechanisms underlying this phenomenon, however, have not been clearly identified. The aim of our study was to evaluate the epidemiological and clinical changes that occurred over the last decade in patients hospitalized in CR departments with high admittance rates.
  
  
  METHODS
  We have retrospectively evaluated all patients admitted between 2002 and 2009 to our division of CR (n = 3340, 1155 female, mean age 66.4 ± 11 years) after recent cardiac surgery. The study population was divided into two homogeneous groups: the four-year period 2002-2005, group A (n = 1614, 540 female, mean age 66.1 ± 10 years) and the four-year period 2006-2009, group B (n = 1726, 615 female, mean age 67.4 ± 11 years). Data were compared using specific indicators of clinical complexity.
  
  
  RESULTS
  Patients aged >75 years were more in group B compared to A (26.3 vs 19.8%, p<0.0001), as well as patients with recent complex surgical interventions, such as combined coronary artery bypass grafting and heart valve surgery (16.4 vs 10.2%, p<0.0001). An increased incidence of cardiovascular death (1.4 vs 0.6%, p=0.02), acute coronary syndrome (1.5 vs 0.7%, p=0.02) and persistent atrial fibrillation/flutter (13.5 vs 7.1%, p<0.0001) was observed in group B, as well as an increased prevalence of systolic heart failure (18.3 vs 9.0%, p<0.0001). Similarly, the incidence of acute respiratory failure episodes (1.0 vs 0.4%, p=0.05), the prevalence of patients admitted with a tracheostomy tube (2.6 vs 0.2%, p<0.0001) and the incidence of acute renal failure (1.1 vs 0.5%, p=0.05) were significantly increased in group B. Postoperative infections and surgical wound complications were 4-fold higher in group B (13.9 vs 3.1%, p<0.0001, and 12.8 vs 2.3%, p<0.0001, respectively). Compared to group A, patients of group B showed a significantly lower physical performance, as expressed by the Rivermead motility index (3.8 ± 1.1 vs 5.2 ± 0.8, p<0.001); moreover, the number of subjects able to perform an incremental training program was significantly lower in group B than group A (14.8 vs 60.6%, p<0.0001). Mean hospital stay was longer in group B than group A (25.4 ± 13 vs 22.1 ± 9 days, p<0.001).
  
  
  CONCLUSIONS
  Our study, by collecting data from a CR division in northern Italy with high admittance rates, demonstrates a dramatic increase in clinical complexity over the last few years. This points to the need for new expertise and major resources to be allocated to CR departments.
authors: U.O.di cardiologia Riabilitativa Specialistica, Istituto Ospedaliero Multimedica, Castellanza. massimo.baravelli@virgilio.it
authors: Massimo
authors: M
authors: Baravelli
authors: Anna
authors: A
authors: Picozzi
authors: Andrea
authors: A
authors: Rossi
authors: Paolo
authors: P
authors: Cattaneo
authors: Daniela
authors: D
authors: Imperiale
authors: Maria Cristina
authors: MC
authors: Rossi
authors: Cecilia
authors: C
authors: Fantoni
authors: Gaia
authors: G
authors: Vezzaro
authors: Laura
authors: L
authors: Crespi
authors: Monica
authors: M
authors: Bosco
authors: Silvana
authors: S
authors: Borghi
authors: Andrea
authors: A
authors: Ballotta
authors: Lorenzo
authors: L
authors: Menicanti
authors: Francesco
authors: F
authors: Donatelli
authors: Edoardo
authors: E
authors: Gronda
authors: Claudio
authors: C
authors: Anzà
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000534:rehabilitation; D005260:Female; D054143:Heart Failure, Systolic / Q000401:mortality; D006349:Heart Valve Diseases / Q000401:mortality* / Q000534:rehabilitation / Q000601:surgery; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D015995:Prevalence; D051437:Renal Insufficiency / Q000401:mortality; D012131:Respiratory Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000706:statistics & numerical data; D016896:Treatment Outcome