EFFECTIVENESS OF COMPREHENSIVE CARDIAC REHABILITATION IN POST CORONARY ARTERY BYPASS GRAFTING PATIENTS

Abstract

Introduction: Cardiovascular disease is leading cause of mortality and morbidity throughout the world. Despite optimum medical and surgical\nmanagement, a large number of patients became unable to maintain normal activity of daily living due to inadequate rehabilitation. Rehabilitation\ncannot be regarded as an isolated form or stage of therapy. Coronary artery bypass surgery, also known as coronary artery bypass graft surgery, is a\nsurgical procedure to bypass the obstructed coronary artery (the target vessel ). India has a large number of patients of coronary artery disease who\nneeds CABG operation. Over few decades post-operative rehabilitation of CABG patients is done though there is no separate national level\nguidelines for Indian population even in post myocardial infarction patients like western countries though socio economic pro\uf001le, health\ninfrastructure and need are different from rest of the world. So, our study is a humble attempt to examine the ef\uf001cacy of rehabilitation programme\nfollowed in western world.\nMaterial and methods: In this Open labelled parallel group prospective randomised trial, conducted in the Department of Physical Medicine and\nRehabilitation in collaboration with the cardio-thoracic and vascular surgery (CTVS) unit of the Institute of Cardio-Vascular Sciences, at the\nInstitute of Post Graduate Medical Education and Research (IPGMER) and SSKM Hospitals, Kolkata between January, 2014 to June, 2015 (18\nmonths). Patients who undergone CABG operation in CTVS Department SSKM Hospital, Kolkata were included. Total 80 patients, 40 in each\ngroup were recruited. Patients were randomised to cardiopulmonary rehabilitation group (n=40); named as cases and usual care group (n=40);\nnamed as control. Institutional ethical committee clearance was taken. Informed consent was taken from each patient before including them in this\nstudy. Every patient was explained about the programme. Parameters used:1. Forced vital capacity (FVC), 2. Metabolic Equivalent (MET), 3.\nFunctional assessment (6MWT). Patient will be assessed at the end of 1 week,6 week and 3month of operation. FVC and 6MWT were performed in\neach visit where MET assessment was done in 6 week and 3 months.\nResults: Data will be summarised by routine descriptive statistics. Numerical variables will be compared between groups by Student s Unpaired t \ntest if normally distributed or by Mann-Whitney s U test if otherwise. Variation over time would be assessed through repeated measures Analysis\nof Variance (ANOVA) or by Friedman s ANOVA if otherwise. Chi-Square test or Fisher s Exact test would be employed for inter-group comparison\nof categorical variance. Analysis will be two-tailed and p<0.05 would be considered statistically signi\uf001cant.\nIn both the groups maximum number of patients are in the age group of 51-60. Most of study population are male (90%). There is statistically\nsigni\uf001cant difference (Student unpaired T test p value <0.01) of MET between cases and controls at 6th week (4.41 vs 3.92) and 3 months (6.93vs\n6.66). Result shows statistically signi\uf001cant difference (Student unpaired T test p value <0.01) of 6MWT between cases and controls at 1 week, 6\nweek and 3 months. Improvement pattern of FVC over time in Rehabilitation group shows that FVC improves in each visit when compared to\nprevious one by Repeated measures ANOVA followed by Tukey s Multiple Comparison Test (P < 0.001Number of time points 3F value 121.85).\nComparison of FVC in usual care group in each visit shows FVC improves in each visit when compared to previous one by Repeated measures\nANOVA followed by Tukey s Multiple Comparison Test as post hoc test if ANOVA returns p value < 0.05 (p<0.001 No. of point 3F value 243.38).\nComparison of 6MWT in Rehabilitation group in each visit shows 6MWT improves in each visit when compared to previous one by Repeated\nmeasures ANOVA followed by Tukey s Multiple Comparison Test as post hoc test if ANOVA returns p vale < 0.05 (Repeated Measures ANOVA P\n< 0.001Number of time points 3 F value 1498.0). Comparison of 6MWT in usual care group in each visit shows 6MWT improves over time\nwhen compared with previous visit by Repeated measures ANOVA followed by Tukey s test as post hoc test if ANOVA returns p value < 0.05 (p\nvalue 0.001 Number of time points 3 F value 580.83). Comparison of MET in Rehabilitation group in each visit show MET improves\nsigni\uf001cantly (4.41 vs 6.93) when compared to earlier one by student paired t test (p <0.01). Comparison of MET in usual care group in each visit\nshow MET improves signi\uf001cantly (3.92 vs 6.66) when compared to earlier one by student paired t test (p <0.01).\nConclusion: th Our study shows most of our patient is male of 5 decade. Both conventional care and comprehensive rehabilitation after CABG\nshows statistically signi\uf001cant improvement in FVC and 6MWT throughout study. Rehabilitation group shows better improvement than usual care\ngroup FVC and 6MWT throughout study. Improvement pattern of MET is consistent from 6 week to 3 months in both the group. Rehabilitation\ngroup shows better improvement in METS from 6 week to 3 months.