The Importance of Cardiac Rehabilitation in Post-Surgery Recovery

Each year, over two million people undergo open-heart surgery.¹ Cardiac surgery is a significant step towards improved heart health for many, but it's only one part of the journey.

While surgery addresses an immediate problem, a comprehensive recovery plan is crucial for long-term well-being and a return to a fulfilling life. This is where cardiac rehabilitation plays a vital role.

What is cardiac rehabilitation?

Cardiac rehabilitation is a medically supervised program designed to improve cardiovascular health in people who have experienced heart issues, including those who have undergone heart surgery. It is a comprehensive, individualized program tailored to each patient's specific needs and abilities and typically involves:

• Exercise training: Supervised physical activity to improve cardiovascular fitness, strength and endurance
• Education: Learning about heart-healthy lifestyle choices, including diet, avoiding smoking, stress management and medication management
• Counseling: Addressing emotional and psychological challenges, such as anxiety, depression and fear, which are common after heart surgery
• Risk factor modification: Identifying and managing risk factors like high blood pressure, elevated cholesterol and diabetes

Cardiac rehabilitation can improve recovery and reduce the risk of additional cardiac complications. The healthier lifestyle that is taught in cardiac rehabilitation can also improve a patient's quality of life, lowering stress and increasing energy levels.

Heart surgery recovery

Immediately after a procedure

For most, recovery and rehabilitation begins almost immediately in the hospital. Patients spend the day after surgery in the intensive care unit (ICU) to be closely monitored. They also begin moving to reduce the risk of complications from prolonged bed rest. The extent of mobilization depends on each patient’s level of tolerance.

Following discharge from the ICU, patients usually spend a few additional days in the acute care, depending on their surgery, age, speed of recovery and additional health issues. On average open heart surgery patients spend five days in an acute care hospital.

Next Steps

Some patients will be ready to go home after their short hospital stay, while others will need additional care. Patients who return home are typically referred to outpatient cardiac rehabilitation.

Patients with persisting medical needs, who require a ventilator to breathe or have other health conditions that may complicate recovery will typically be referred to inpatient post-acute care.

Linda’s story

Linda Betancourt underwent surgery to fix her mitral valve regurgitation, a condition where the mitral valve in the heart does not close properly, allowing blood to leak backward. This condition was causing her heart failure.

During the procedure, Linda suddenly went into cardiac arrest. The medical team revived her, but Linda couldn’t breathe without a ventilator. Complications cascaded from there. Her kidneys began to fail, requiring dialysis and multiple intravenous antibiotics to fend off infection.

Post-acute care

When post-acute care is needed, it’s important to know your options and work with your doctor to identify the right level of care for optimal recovery. These options include a critical illness recovery hospital and/or an inpatient rehabilitation hospital.

Both settings support recovery through a medically supervised program by providing evidence-based therapies to restore independence. Here, patients are also provided resources to address and prevent symptoms, adopt healthy lifestyle habits and manage any current health conditions or cardiac risk factors.

Critical Illness Recovery Hospital

This level of specialized care is geared to patients who still require intensive monitoring and nursing care.

For most heart surgeries, patients are placed on a ventilator to manage breathing during the procedure. Some patients struggle to breathe on their own after surgery and a critical illness recovery hospital is often the right next step.

While at a critical illness recovery hospital, the focus is on the skills, strategies and techniques needed to restore strength, avoid complications and advance safely and confidently. Early rehabilitation concentrates on the five focus areas of recovery. Patients work on overcoming medical obstacles while also working to regain their independence to breathe, eat, walk, talk and think.

The multi-disciplinary care team will establish specific cardiac parameters and monitor patients closely, particularly during exercise, rest periods and recovery after exercise. In addition, care and extensive training is provided to help:

• Protect an incision while dressing, grooming and bathing
• Practice sternal precautions
• Follow guidelines to minimize pain, swelling and the risk of potential complications
• Maintain blood pressure and cholesterol levels
• Improve any vocal or swallowing issues
• Use adaptive equipment to facilitate self-care activities
• Safely transfer to a chair, commode or shower
• Move in and out of bed and turn properly
• Adapt new ways of performing daily activities
• Conserve energy

Overall, a critical illness recovery hospital provides more intensive medical services for a longer duration and introduces physical rehabilitation at a slower pace to give patients the time they need to recover.

Linda’s story

After a month, Linda was referred to Select Specialty Hospital – Birmingham*, a critical illness recovery hospital that provides extended recovery.  She arrived unable to breathe on her own, speak, eat or move without assistance. She needed dialysis and wound care. A treatment plan, led by a physician overseeing a multidisciplinary team of health professionals, was put in place to get Linda on the path back home.

• Respiratory therapists began to gradually reduce ventilator settings and led breathing and chest exercises, expanding Linda’s lung capacity and endurance. Within three weeks, she was freed from the ventilator.
• Linda’s physical and occupational therapists began a mobility program soon after she arrived. Using range of motion exercises, they manipulated her arms to get blood flowing with Linda responding more purposefully each day.
• Speech therapists led mouth, jaw and tongue exercises to restore Linda’s ability to swallow and speak.
• Over time, Linda’s kidneys healed and she no longer needed dialysis.

Inpatient Rehabilitation Hospital

Patients who are stable but may require some medical monitoring, nursing care, and assistance to mobilize, may be referred to an inpatient rehabilitation hospital. To be admitted patients must be able to tolerate three hours of therapy, five days a week. This is usually a combination of physical and occupational therapy. Speech therapy is also available if needed. Therapy is typically done in four 45-minute sessions spaced throughout the day. The sessions focus on building strength, increasing independence and educating patients on managing their cardiac health through a healthy lifestyle.

While at an inpatient rehabilitation hospital, patients work on the activities of daily life – showering, dressing, typical household tasks –  to prepare for their return home. Patients who have undergone cardiac surgery often require increased assistance and time to complete everyday tasks and may need to take frequent rest breaks. This is typically due to a combination of factors – shortness of breath, limited endurance, pain and activity restrictions such as sternal precautions. Patients are educated in energy conservation strategies, self-pacing, breathing techniques and how to use adaptive equipment.

A common misconception is that exercise is dangerous following cardiac surgery. On the contrary, an individualized, medically supervised exercise program is not only safe, but plays a significant role in the recovery process. Patients begin their exercise program here and are taught to monitor their breathing, heart rate and exertion levels after discharge.

Linda’s story

Linda was ready for the next step in her recovery and transferred to Ochsner Rehabilitation Hospital*, an inpatient rehabilitation hospital in New Orleans. Here she continued moving toward her goals of returning home and enjoying her previous active lifestyle.

When she arrived at Ochsner, Linda was unable to stand without the assistance of two people, and couldn’t walk due to weakness and shortness of breath. She also was unable to bathe or dress herself. Linda’s goals included standing, walking and performing self-care tasks with independence.

• In physical therapy, Linda worked on standing and walking. Early on, Linda could only stand for a few seconds and did so with assistance, but she progressed to standing for longer periods of time with minimal help.
• Occupational therapists focused on improving Linda’s independence with dressing, bathing and toileting. She started out needing moderate assistance and over time was able to do each of these activities more independently.
• With nursing, Linda learned to manage her medications and how to monitor her blood pressure to help manage and prevent future complications.
• Linda’s family was on hand during portions of her therapy sessions and attended family training, which gave them the knowledge, skills and confidence to support Linda when she returned home.

After 29 days, Linda met her goals of standing from her wheelchair with just a little help, walking with a rolling walker and performing self-care activities independently.

Outpatient Rehabilitation

When a patient no longer needs inpatient care – acute or post-acute – they often continue recovering with an outpatient program. Depending on the type of surgery, overall recovery to rebuild strength, stamina and to resume daily life may take weeks to months.

Outpatient programs also educate patients to manage their risk factors and other medical conditions that can affect heart health. Participating in an outpatient cardiac rehabilitation program has been shown to reduce risks of death, reduce hospital readmissions, and improve quality of life.²

Linda’s story

Linda planned to continue recovery with home health therapy services and an outpatient cardiac rehabilitation program. She even set her next goals of riding her bike and exercising on the treadmill again.

Read more of Linda’s story or find more patient success stories.

Managing heart health

After a full recovery from surgery, it's crucial to maintain a heart-healthy lifestyle and continue with regular medical checkups.

Maintaining a heart-healthy lifestyle, includes:

• Taking prescribed medication (remember to report any side effects)
• Eating a well-balanced, healthy diet
• Exercising regularly
• Maintaining a healthy weight
• Managing stress
• Avoiding smoking

Managing your heart health after cardiac surgery is a lifelong commitment. By embracing a heart-healthy lifestyle, adhering to your medication regimen, and seeking regular medical care, you can significantly improve your quality of life and enjoy a healthier, more fulfilling future.

Learn more about cardiac rehabilitation or contact us to inquire if our nationwide network of post-acute care is the right step in recovery.

*Penn State Health Rehabilitation Hospital is part of Select Medical's nationwide network of post-acute care.

References: 

1. What is heart surgery? | NHLBI, NIH. (2022, June 1). NHLBI, NIH.
https://www.nhlbi.nih.gov/health/heart-surgery#:~:text=Heart%20surgery%20is%20done%20to,to%20treat%20various%20heart%20problems

2. Ades, P. A., Keteyian, S. J., Wright, J. S., Hamm, L. F., Lui, K., Newlin, K., Shepard, D. S., & Thomas, R. J. (2017). Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clinic proceedings, 92(2), 234–242. https://doi.org/10.1016/j.mayocp.2016.10.014