Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Prehabilitation: evolving role in contemporary cardiac surgery

Nature Reviews Cardiology volume 20, pages 793–794 (2023)Cite this article

Subjects

The population of patients who undergo cardiac surgery is becoming older and more medically complex, and frailty is increasingly prevalent. Prehabilitation is a multicomponent programme intended to better prepare these vulnerable patients for the stresses of surgery. Nonetheless, the effectiveness, implementation and effects on long-term outcomes of prehabilitation have not been clearly established. In particular, frailty might not be easily mitigated by prehabilitation.

Although the number of cardiac surgery procedures is declining worldwide, >210,000 procedures are still being performed annually in the USA. Furthermore, the average life expectancy of individuals is increasing and typical candidates for cardiac surgery have become older, with added risks of perioperative and postoperative complications associated with the complexities of cardiovascular disease (CVD) in older age (such as calcification, stiffening, remodelling and other structural and physiological challenges), increased comorbid conditions (CVD and non-CVD), and geriatric syndromes. Frailty is a geriatric syndrome that is highly prevalent in adults with CVD, including 20–50% of patients who undergo cardiovascular surgery, and entails fundamental changes in cell physiology with associated changes in body composition (particularly sarcopenia) and metabolism (particularly insulin resistance), with overall depletion of physiological reserves1. Frailty is associated with a fivefold increase in major complications during and after cardiac surgery. Even if the surgery is technically successful, 20% of patients with frailty have postoperative functional decline and disability or die within 1 year. Similarly, even if transcatheter procedures are used instead of surgery, frailty portends a substantially increased risk of suboptimal outcomes.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. Fried, L. P. et al. The physical frailty syndrome as a transition from homeostatic symphony to cacophony. Nat. Aging 1, 36–46 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Steinmetz, C., Bjarnason-Wehrens, B., Walther, T., Schaffland, T. F. & Walther, C. Efficacy of prehabilitation before cardiac surgery: a systematic review and meta-analysis. Am. J. Phys. Med. Rehabil. 102, 323–330 (2023).

    Article  PubMed  Google Scholar 

  3. Marmelo, F., Rocha, V. & Moreira-Gonçalves, D. The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: systematic review and meta-analysis. Eur. J. Prev. Cardiol. 25, 404–417 (2018).

    Article  PubMed  Google Scholar 

  4. Steinmetz, C. et al. Prehabilitation in patients awaiting elective coronary artery bypass graft surgery - effects on functional capacity and quality of life: a randomized controlled trial. Clin. Rehabil. 34, 1256–1267 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Arthur, H. M., Daniels, C., McKelvie, R., Hirsh, J. & Rush, B. Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized, controlled trial. Ann. Intern. Med. 133, 253–262 (2000).

    Article  CAS  PubMed  Google Scholar 

  6. Rosenfeldt, F. et al. Physical conditioning and mental stress reduction–a randomised trial in patients undergoing cardiac surgery. BMC Complement. Altern. Med. 11, 20 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sawatzky, J. A. et al. Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study. Clin. Rehabil. 28, 648–657 (2014).

    Article  PubMed  Google Scholar 

  8. Akowuah, E. F. et al. A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery. Anaesthesia 78, 1120–1128 (2023).

    Article  CAS  PubMed  Google Scholar 

  9. Rouleau, C. R. et al. An observational study examining utilization of prehabilitation and its association with postoperative cardiac rehabilitation participation and risk factors following coronary artery bypass grafting. Int. J. Cardiol. 362, 28–34 (2022).

    Article  PubMed  Google Scholar 

  10. Lai, F. Y., Abbasciano, R. G., Tabberer, B., Kumar, T. & Murphy, G. J. Identifying research priorities in cardiac surgery: a report from the James Lind Alliance Priority Setting Partnership in adult heart surgery. BMJ Open 10, e038001 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Duke University Health System, Durham, NC, USA

    Atilio Barbeito

  2. Anesthesiology Service, VA Healthcare System, Durham, NC, USA

    Atilio Barbeito

  3. Department of Medicine, Divisions of Geriatrics and Cardiology, University of Pittsburgh, Pittsburgh, PA, USA

    Daniel E. Forman

  4. Pittsburgh Geriatric Research Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Daniel E. Forman

Authors
  1. Atilio Barbeito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel E. Forman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel E. Forman.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barbeito, A., Forman, D.E. Prehabilitation: evolving role in contemporary cardiac surgery. Nat Rev Cardiol 20, 793–794 (2023). https://doi.org/10.1038/s41569-023-00939-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41569-023-00939-2

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing