A new cardiac prehab program at Banner-University Medical Center Phoenix improved frailty and measures of functional capacity for heart failure patients, and allowed more patients to receive surgery who otherwise wouldn’t have qualified.
Many decompensated heart failure patients are in need of advanced therapies, but cannot be discharged to become eligible for those therapies due to how far their disease has progressed. When these people are hospitalized, they lose functional capacity and become frail from being bed-bound, Radha Gopalan, MD, director of the advanced heart failure and transplant program at Banner-University Medical Center Phoenix, said in an episode of Becker’s “Cardiology+ Heart Surgery Podcast.” Hospitals generally do not have the ability to provide physical therapy, and once patients are discharged, they have to wait six weeks before they can start outpatient cardiac rehabilitation.
This leaves many patients in limbo — unable to be discharged but too frail to be eligible for immediate surgery. And this is where inpatient prehab-rehab has made all the difference.
Banner’s inpatient cardiac prehab-rehab program is housed inside the hospital, available to patients who are currently hospitalized. Its goal is to decrease frailty and increase functional capacity so patients can become eligible for transplant or mechanical circulatory support surgery. To do this, it combines prehab, which helps patients prepare for procedures they urgently need, with rehab, which prepares them to return home post-surgery, Dr. Gopalan said.
Since launching in 2023, the program has helped 47 patients, including patients preparing for or who received a transplant, total artificial heart implantation or LVAD.
About 69% of these patients attended more than one training session in the inpatient rehab facility, 50% improved METs, measures of functional capacity, and 44% improved frailty or maintained the same level of functional capacity.
“What I really want to highlight, though, is what we were most worried about in the first two years: adverse events and safety concerns,” Dr. Gopalan said. “We saw none — no adverse events or safety concerns based on our protocol when patients went through prehab and rehab at this facility.”
Now, Dr. Gopalan is looking to change the inclusion and exclusion criteria to allow more patients into the program, eliminate barriers to participation and bring the program to intensive care patients.
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