Potential benefits of outpatient rehabilitation for patients with post-intensive care syndrome admitted to cardiovascular ICU

Purpose Prolonged decline in physical, cognitive, and mental functions following intensive care management is recently known as post-intensive care syndrome (PICS), which is associated with a worse prognosis. In the nationwide registry, PICS is likely prevalent in patients with cardiovascular disease (CVD). While outpatient rehabilitation is widely recognised to improve functional outcomes in patients with CVD, its potential benefits for patients with PICS following cardiovascular intensive care unit (ICU) is unclear. Methods In this observational study, we included 738 patients who were admitted to a cardiovascular ICU of a tertiary university hospital and received acute-phase rehabilitation during hospitalisation. PICS condition at hospital discharge was defined by at least one of the following statuses based on the previous study: gait speed < 0.8 m/sec, Mini-Cog < 3, and Patient Health Questionnaire-2 (PHQ-2) > 2 as the decline in physical, cognitive, and mental function, respectively. The outpatient rehabilitation program included physical exercises, education on disease management, and counselling. The primary endpoint of this study was composite events of all-cause death or readmission due to heart failure for three years after hospital discharge. We examined the association between participation in outpatient rehabilitation and the primary endpoint in subgroups of the PICS status using multivariate Cox proportional hazard model adjusted for clinical characteristics. We also compared changes in physical, cognitive, and mental functions following outpatient rehabilitation between the PICS status using the multivariate mixed effects models. Results Among the studied patients, 300 (40.7%) showed PICS: 134 (18%), 118 (16%), and 157 (21%) had declines in physical, cognitive, and mental functions, respectively, and 390 (52.8%) participated in outpatient rehabilitation. During the median follow-up of 729 days, 99 events (13.4%) occurred. Outpatient rehabilitation participation was significantly associated with lower composite events in all patients (adjusted hazard ratio: 0.51, 95% confidence interval: 0.41-0.63) and those with or without PICS condition (Figure 1). The positive changes in gait speed and Mini-cog and negative change in PHQ-2 were observed; changes in Mini-cog and PHQ-2 were relatively higher in patients with PICS than those without (P for interaction for gait speed, Mini-cog, and PHQ-2: 0.072, 0.031, and <0.001, respectively, Figure 2). Conclusion Even if patients have PICS at hospital discharge, outpatient rehabilitation potentially contributes to better clinical outcomes in these patients following cardiovascular ICU. The benefits of outpatient rehabilitation for readmission rate and gait speed are similar to those without PICS, but cognitive and mental conditions likely much improve in patients with PICS.