TY - JOUR
T1 - “NEW” Prehabilitation
T2 - A 3-Way Approach to Improve Postoperative Survival and Health-Related Quality of Life in Cardiac Surgery Patients
AU - Arora, Rakesh C.
AU - Brown, Charles H.
AU - Sanjanwala, Rohan M.
AU - McKelvie, Robert
N1 - Funding Information:
R.C.A. has received an unrestricted educational grant from Pfizer Canada Inc, and honoraria from Mallinckrodt Pharmaceuticals for work unrelated to this work. C.H.B has received funding from Medtronic unrelated to this work, as well as grant support from the National Institutes of Health/National Institute on Aging (AG057020). R.M. has received honoraria from Novartis and Servier unrelated to this work, and grant support from Servier unrelated to this work. R.M.S. has no financial ties to disclose. The authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2018 Canadian Cardiovascular Society
PY - 2018/7
Y1 - 2018/7
N2 - With advances in health care practices and delivery, the overall life expectancy of the Western population has increased. For those practitioners involved in the care of the patient with advanced cardiac disease, there has been a resultant higher prevalence of increasingly frail and older patients undergoing complex cardiac procedures. The higher rates of comorbid-associated higher vulnerability, with associated deconditioning, predisposes older, frail patients to poorer postoperative outcomes and a complicated recovery process after cardiac surgery. In addition, such patients experience inferior quality of life as a result of reduced ability to independently perform activities of daily living. During the preoperative waiting period, the cardiac symptoms and anxiety induces inactivity that in turn compounds the physical and mental deconditioning. To improve functional capacity and enhance postoperative recovery, prehabilitation, a component of the enhanced recovery after surgery model, might be of particular importance. In some studies, the preoperative improvement of the baseline physical, nutritional, and mental status has been reported to improve postoperative outcomes and enhance recovery after cardiac surgery. To address these domains, a 3-way approach to prehabilitation that is targeted toward improving nutritional status (N), exercise capacity (E) and worry reduction (W) (nutrition, exercise, and worry; “NEW” approach) might facilitate the perioperative management by ameliorating the postoperative outcomes and alleviating the surgical stress-related health deconditioning. In this review, the NEW approach and its potential benefits on postoperative outcomes as well as an implementation model (Promoting Action on Research Implementation in Health Services [PARiHS] framework) to aid institutional level implementation is described.
AB - With advances in health care practices and delivery, the overall life expectancy of the Western population has increased. For those practitioners involved in the care of the patient with advanced cardiac disease, there has been a resultant higher prevalence of increasingly frail and older patients undergoing complex cardiac procedures. The higher rates of comorbid-associated higher vulnerability, with associated deconditioning, predisposes older, frail patients to poorer postoperative outcomes and a complicated recovery process after cardiac surgery. In addition, such patients experience inferior quality of life as a result of reduced ability to independently perform activities of daily living. During the preoperative waiting period, the cardiac symptoms and anxiety induces inactivity that in turn compounds the physical and mental deconditioning. To improve functional capacity and enhance postoperative recovery, prehabilitation, a component of the enhanced recovery after surgery model, might be of particular importance. In some studies, the preoperative improvement of the baseline physical, nutritional, and mental status has been reported to improve postoperative outcomes and enhance recovery after cardiac surgery. To address these domains, a 3-way approach to prehabilitation that is targeted toward improving nutritional status (N), exercise capacity (E) and worry reduction (W) (nutrition, exercise, and worry; “NEW” approach) might facilitate the perioperative management by ameliorating the postoperative outcomes and alleviating the surgical stress-related health deconditioning. In this review, the NEW approach and its potential benefits on postoperative outcomes as well as an implementation model (Promoting Action on Research Implementation in Health Services [PARiHS] framework) to aid institutional level implementation is described.
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U2 - 10.1016/j.cjca.2018.03.020
DO - 10.1016/j.cjca.2018.03.020
M3 - Review article
C2 - 29960613
AN - SCOPUS:85048715138
SN - 0828-282X
VL - 34
SP - 839
EP - 849
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
IS - 7
ER -