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FARSTER: Feasibility Study of Early Outpatient Review and Early Cardiac Rehabilitation After Coronary Artery Bypass Grafting: Mixed Methods Research Design

In the UK, heart operations have steadily increased since 2010. Of the 36,134 operations performed in 2013, 17,630 were isolated coronary artery bypass grafting (CABG). Following CABG, patients currently attend their first outpatient review six weeks after hospital discharge, where recovery is assessed and fitness to commence cardiac rehabilitation (CR) is determined. CR is then started from eight weeks. There is no research to support the timings of either the outpatient check-up or the start of cardiac rehabilitation. The long interval before postoperative review and CR extends the period of vulnerability and inactivity for patients. Our proposed study will examine the feasibility of bringing forward outpatient review and CR, in order to facilitate recovery, physical fitness and quality of life.

During this 18-month feasibility study, we plan to recruit 100 patients undergoing a planned CABG through a median sternotomy, at two NHS hospitals over five months. Half of the participants will be randomly assigned to a novel, shortened pathway including a postoperative review three weeks after hospital discharge, followed by commencement of CR from four weeks. The remainder will continue with usual treatment. CR for both groups will involve exercise classes once or twice a week for eight weeks, and fitness tests. Patients will then have a final assessment at 26 weeks, with clinical examination, fitness and breathing tests, and completion of a general health questionnaire.

Outcomes will be measured through a variety of standard clinical tests as well as questionnaires. Additionally, we will collect qualitative data through interviews, diary entries and focus group meetings with consenting participants and clinical staff. We will analyse patients’ and staff experiences, patient fitness levels, delivery of the trial, quality of life and costs, associated with each pathway.

If you would like to find out more about this study, please contact Natasha Mitchell – natasha.mitchell@york.ac.uk (01904 321655)

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