[The Complex Program of Rehabilitation of Patients With Ischemic Heart Disease After Coronary Artery Bypass Surgery in Ambulatory Cardiorehabilitational Department: Clinical Effects of Third Stage of Rehabilitation]

Abstract

Purpose: to assess clinical efficacy of early post discharge rehabilitation of patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) in conditions of a polyclinical department of cardiological rehabilitation (stage III of cardiorehabilitation).

Material and methods: We included in this study 36 men with IHD in 3-8 weeks (mean 7.8+/-1.6 weeks) after CABG. Patients were randomized in 2groups: patients of the main group attended special "School for patients recovering after CABG" [School] (60-80 min sessions once a week for 5 weeks) and participated in a program of monitored (up to 60 min 3 times a week for 4 months) and unmonitored (home based) exercise training. Patients of the control group attended School and were given advice to do physical exercises at home. Follow up duration was 1 year.

Results: Main group. Compared with baseline values after 4 months exercise duration increased 32.6% (p<0.05), this effect persisted at 12 month; threshold exercise load increased 35.2% (p<0.05) after 4, 53.9% after 6, and 49.5% after 12 month. After 4 and 12 months of training some increases of left ventricular (LV) ejection fraction and stroke volume, and decrease of LV end systolic volume occurred. Physical training in this group was associated with improvement of parameters of quality of life. During 12 months of follow up there were no significant changes of concentrations of total and low density lipoprotein cholesterol (TC, LDLC). In the control group slight increase of exercise duration was observed only at 12 months (9.8%, p<0.05), and it was not accompanied by dynamics of exercise tolerance. Increases of concentrations of TC (10.2%, p<0.05) and LDLC (15.6%, p<0.05) were registered at 12 months. Serious cardiovascular complications in the main group (physical training + educational School) were three times less frequent than in the control group (attendance of School only) (11.1 vs. 39.2%, respectively.

Keywords: coronary artery bypass grafting; ischemic heart disease; patient education; physical training; rehabilitation.