Effectiveness of Comprehensive Cardiac Rehabilitation in Post Coronary Artery Bypass Grafting Patients

Introduction: Cardiovascular disease is leading cause of mortality and morbidity throughout the world. Despite optimum medical and surgical management, a large number of patients became unable to maintain normal activity of daily living due to inadequate rehabilitation. Rehabilitation cannot be regarded as an isolated form or stage of therapy. Coronary artery bypass surgery, also known as coronary artery bypass graft surgery, is a surgical procedure to bypass the obstructed coronary artery (the "target vessel"). India has a large number of patients of coronary artery disease who needs CABG operation. Over few decades post-operative rehabilitation of CABG patients is done though there is no separate national level guidelines for Indian population even in post myocardial infarction patients like western countries though socio economic prole, health infrastructure and need are different from rest of the world. So, our study is a humble attempt to examine the efcacy of rehabilitation programme followed in western world. Material and methods: In this Open labelled parallel group prospective randomised trial, conducted in the Department of Physical Medicine and Rehabilitation in collaboration with the cardio-thoracic and vascular surgery (CTVS) unit of the Institute of Cardio-Vascular Sciences, at the Institute of Post Graduate Medical Education and Research (IPGMER) and SSKM Hospitals, Kolkata between January, 2014 to June, 2015 (18 months). Patients who undergone CABG operation in CTVS Department SSKM Hospital, Kolkata were included. Total 80 patients, 40 in each group were recruited. Patients were randomised to cardiopulmonary rehabilitation group (n=40); named as cases and usual care group (n=40); named as control. Institutional ethical committee clearance was taken. Informed consent was taken from each patient before including them in this study. Every patient was explained about the programme. Parameters used:1. Forced vital capacity (FVC), 2. Metabolic Equivalent (MET), 3. Functional assessment (6MWT). Patient will be assessed at the end of 1 week,6 week and 3month of operation. FVC and 6MWT were performed in each visit where MET assessment was done in 6 week and 3 months. Results: Data will be summarised by routine descriptive statistics. Numerical variables will be compared between groups by Student's Unpaired 't' test if normally distributed or by Mann-Whitney's 'U' test if otherwise. Variation over time would be assessed through repeated measures Analysis of Variance (ANOVA) or by Friedman's ANOVA if otherwise. Chi-Square test or Fisher's Exact test would be employed for inter-group comparison of categorical variance. Analysis will be two-tailed and p<0.05 would be considered statistically signicant. In 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 signicant 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 6.66). Result shows statistically signicant difference (Student unpaired T test p value <0.01) of 6MWT between cases and controls at 1 week, 6 week and 3 months. Improvement pattern of FVC over time in Rehabilitation group shows that FVC improves in each visit when compared to previous one by Repeated measures ANOVA followed by Tukey's Multiple Comparison Test (P < 0.001Number of time points 3F value 121.85). Comparison of FVC in usual care group in each visit shows FVC improves in each visit when compared to previous one by Repeated measures ANOVA 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). Comparison of 6MWT in Rehabilitation group in each visit shows 6MWT improves in each visit when compared to previous one by Repeated measures ANOVA followed by Tukey's Multiple Comparison Test as post hoc test if ANOVA returns p vale < 0.05 (Repeated Measures ANOVA P < 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 when 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 value 0.001 Number of time points 3 F value 580.83). Comparison of MET in Rehabilitation group in each visit show MET improves signicantly (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 show MET improves signicantly (3.92 vs 6.66) when compared to earlier one by student paired t test (p <0.01). Conclusion: th Our study shows most of our patient is male of 5 decade. Both conventional care and comprehensive rehabilitation after CABG shows statistically signicant improvement in FVC and 6MWT throughout study. Rehabilitation group shows better improvement than usual care group FVC and 6MWT throughout study. Improvement pattern of MET is consistent from 6 week to 3 months in both the group. Rehabilitation group shows better improvement in METS from 6 week to 3 months.