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November 01, 2019

Despite benefits, many cardiac valve surgery patients don't receive cardiac rehabilitation

Those who receive rehabilitation have fewer hospitalizations following surgery, study finds

Less than half of cardiac valve surgery patients receive cardiac rehabilitation despite proven positive outcomes, a new study says.

The benefits of cardiac rehabilitation for patients who experience a heart attack or undergo coronary artery bypass graft surgery are well-known. Less attention seems to be given to how it also aids in the recovery from cardiac valve surgery.

"Cardiac rehabilitation is a customized outpatient program of exercise and education," designed to improve recovery from heart disease and surgeries used to treat heart disease, according to the Mayo Clinic

Though some medical institutions, like the Mayo Clinic and Penn Medicine, list cardiac rehabilitation as part of the recovery process after heart valve surgery. But the latest study, published by the Journal of the American Medical Association, shows that not everyone who can benefit from it actually receives it.

The study found that only 17,855 of 41,369 Medicare beneficiaries who had open valve surgery in the United States in 2014 were enrolled in cardiac rehabilitation programs. Asian, black and Hispanic patients were less likely to be enrolled than white patients.

Researchers also found that patients who also had coronary artery bypass grafting surgery were more likely to receive cardiac rehabilitation than those just scheduled for heart valve surgery. 

Researchers also examined the outcomes associated with cardiac rehabilitation for heart valve patients. These patients typically experienced fewer hospitalizations during the first year after surgery. They also had a 4.2% decrease in one-year mortality risk.

According to Reuters, the study did not explore why patients were not asked to enroll in cardiac rehabilitation, or why they might not have taken advantage of it. The study also was not designed to find any direct causal relationships.

Cardiac valve surgery patients "will recover quicker, feel better, function better, and live longer as a result," Dr. Randall Thomas, co-author of an editorial that accompanied the study in JAMA, and medical director of cardiac rehabilitation at the Mayo Clinic in Rochester, Minnesota, told Reuters in an email.

"If a center-based program is not available near them, they should ask about the options for a home-based cardiac rehabilitation program that would be available to them instead," he added.

A 2015 study in the Journal of Cardiopulmonary Rehabilitation and Prevention found that heart valve surgery patients have similar improvements to their aerobic fitness after cardiac rehabilitation as coronary artery bypass graft surgery patients. And a 2017 study in the same journal found that this type of rehab after heart valve surgery was linked to reduced mortality risk.

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