Effect of cardiac rehabilitation on intensity of physical activity according to type of surgery and Eurscore II after open heart surgery

Abstract

Funding Acknowledgements Type of funding sources: None. Introduction Patients after open heart surgery require cardiac rehabilitation (CR), as reconstructive surgery reduces the quality of life. A perioperative EuroSCORE II score is used for assessment of risk of worse outcomes after surgery. Few is known whether CR is feasible in patients undergoing open heart surgery with moderate and high risk Euroscore II and whether the intensity of physical activity (PA) varies according to the type of heart surgery. Objective To evaluate effect of CR on perceived intensity of PA and target heart rate in patients who underwent open heart surgery and different EurSCORE II scale. Methods The retrospective cohort study included 104 patients who underwent open heart surgery and stage 2 CR: group 1- 64 patients with coronary artery bypass surgery (CABG), group 2 - 40 patients with valvular heart disease (VHD) surgery. We evaluated following parameters: subjective assessment of PA intensity on the Borg scale and objective assessment on the achievement of the training heart rate before and after CR. The perioperative risk of worse outcomes was assessed using EuroSCORE II scale. Results According to the EuroSCORE II scale: 1st group patients were at: -low risk -21%, moderate risk -68%, high risk -11% and 2nd group - low risk 29%, moderate risk 54%, and high risk 17%. None of patients had adverse effects of CR. In the first group, the subjective assessment on the Borg scale before CR was slightly higher than in the second group: -2.43 ± 0.09 points vs. 2.22 ± 0.11 points before CR. At the end of the CR, there was a significant increase (p<0.05) in perception of intensity of PA in both groups - the 1st group –4.37 ± 0.06 points and in 2nd group - 4.35 ± 0.07 points. Target heart rate before CR did not differ between groups: group 1 - 75 ± 5.7 beats per minute and group 2 - 89 ± 7.7 beats per minute (p=0.552): after CR there was a significant decrease in heart rate: group 1 - 55 ± 2.2 bpm, group 2 - 61 ± 3.2 bpm (p =.0012). Conclusion 1. CR increases significantly intensity of physical activity in pts after open heart surgery 2. Though the VHD surgery pts might have lower intensity of PA before CR, the intensity of PA after CR did not differ between CABG and VHD surgeries, increasing in both groups. 3. Patients with moderate and high EurSCORE II risk comprised 80 and 69% of patients in our cohort, none of them experienced adverse effect of CR and had improvement of PA and achieved target heart rate.