title: Safety of early enrollment into outpatient cardiac rehabilitation after open heart surgery.
abstract: The safety of early enrollment (<2 weeks after hospital discharge) into cardiac rehabilitation (CR) after recent coronary artery bypass graft (CABG) surgery or heart valve surgery (HVS) has not previously been assessed and has important policy implications. Consequently, we performed a detailed review of all clinical adverse events within 6 months of hospital discharge. We compared early and late attendees for patients undergoing CABG surgery or HVS and included patients with myocardial infarction (MI) as an additional control group. We analyzed 112 patients undergoing CABG surgery, 69 patients undergoing HVS, and 59 patients with MI. Median time (interquartile range) from hospital discharge to CR enrollment was 10.5 (8 to 15), 12 (8.5 to 21), and 9 days (7 to 14), respectively. There was no difference in major event rates between early and late enrollees (17% vs 17%, respectively, log-rank p = 0.98) or by diagnosis (15%, 16%, and 22% for CABG surgery, HVS, and MI, respectively; log-rank p = 0.50). Sternal instability and wound infection rates were similar. CR-related adverse events trended toward increased event rates in surgical and early enrollees, but of 44 events, only 3 were exercise related, none resulted in permanent harm, and 41 (93%) were managed in CR without need for emergency services. In conclusion, it appears that a policy of encouraging early enrollment into CR in patients with a recent open heart surgery seems unlikely to harm patients when careful individualized assessment and exercise prescription take place within the bounds of an established CR program.
authors.affiliation: Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts; Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, Massachusetts. Electronic address: Quinn.pack@gmail.com.
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.affiliation: Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kent J
authors.initials: KJ
authors.lastname: Dudycha
authors.affiliation: Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kyle P
authors.initials: KP
authors.lastname: Roschen
authors.affiliation: Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
authors.affiliation: Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Squires
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D010045:Outpatients; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome