A new smartphone app designed to prep cardiac surgery patients significantly cuts the risk of major adverse cardiovascular events (MACE) within a year post-surgery.
This is according to a surgeon-led randomised controlled trial.
The ‘teleprehabilitation’ app, developed to provide personalised pre-surgery care remotely, cut the rate of complications primarily by reducing rehospitalisations.
The findings, presented at the European Association for Cardio-Thoracic Surgery (EACTS) 2024 meeting by Dr Bart Scheenstra of Maastricht University Medical Centre in the Netherlands, suggest that virtual ‘prehab’ might improve patient outcomes by intervening weeks before surgery.
Dr Scheenstra explained: ‘Cardiac surgery saves lives, no doubt, but what if we could improve patient outcomes by starting cardiac rehabilitation programs already weeks before surgery?’
The teleprehabilitation programme includes support for smoking cessation, dietary advice, exercise guidance, inspiratory muscle training and patient education – all provided online to patients awaiting elective cardiac surgeries.
The trial included 394 patients, with an average age of 66, with 75% male. About 40% of participants underwent coronary surgery, another 40% had valvular procedures, and the remaining 20% received other cardiac procedures.
By offering virtual support six to eight weeks before surgery, the app successfully lowered MACE rates from 25.5% in the standard-care group to 16.8% in the teleprehab group.
The benefit was primarily attributed to fewer repeat hospitalisations, which dropped to 3% in the teleprehab group versus 8.7% in controls.
While the overall difference was not statistically significant after adjusting for factors like smoking status and intervention type, the teleprehab approach yielded notable results in specific high-risk subgroups, such as women and those with elevated cardiovascular risk scores.
Beyond reducing complications, teleprehabilitation improved patients’ quality of life scores a year after surgery and lowered rates of smoking, pulmonary risk and depression by the time of the procedure. However, no significant differences were found between the groups regarding hospital stay duration, physical fitness, or post-surgery complications.
Dr Patrick Myers of Lausanne University Hospitals highlighted the study’s significance: ‘This is a high-quality RCT designed by surgeons to improve surgical outcomes.’
The findings, he added, underscore the value of pre-surgery risk reduction for all surgical staff, including anaesthetists and cardiologists.
While the study did not assess the potential for pre-surgery weight loss interventions, Scheenstra noted that new weight-loss medications could be integrated into future teleprehab programs to address issues like obesity.
He also acknowledged a possible need to balance the timing of surgery with the benefits of prehabilitation, which could make surgeons consider postponing procedures for some patients to achieve optimal outcomes.
