Patient mortality in the 12 years following enrolment into a pre-surgical cardiac rehabilitation programme

Objective: This study examined whether involvement in a pre-surgical cardiac rehabilitation programme conferred a long-term survival benefit. Design: Patients randomly allocated to a pre-surgical cardiac rehabilitation programme intervention or a control group were tracked through national databases at a point approximately 12 years later, and all causes of mortality were identified from death records. Kaplan-Meier survival analyses based on involvement in a cardiac rehabilitation programme and known pre-surgical risk factors were carried out. Setting: Two health boards in the west of Scotland, referring to a single cardiothoracic tertiary centre. Subjects: Patients admitted to the waiting list for coronary artery bypass surgery. Interventions: Patients were randomly allocated to a control group ('usual' care) or an intervention group (nurse-led cardiac rehabilitation) in the pre-operative phase. They were followed up at 12 years post surgery. Main measures: The only outcome measure used for analysis was survival. Measures of anxiety and depression, and physiological and lifestyle risk factors were included as independent variables in analysis of death. Results: The initial study included 110 patients - none were lost to follow-up. Relative risk of death associated with inclusion in the cardiac rehabilitation programme was 0.814; risk of death increased with increasing pre-surgical depression (RR 1.07) and anxiety (RR 1.09). Conclusions: Undertaking pre-surgical cardiac rehabilitation confers a long-term survival advantage over patients not offered this service. Increased anxiety and depression in the pre-surgical phase are additional risk factors for increased mortality.