Heart Transplant: Delaying Cardiac Rehab Increases Health Risks

After a heart transplant (HT), recipients are at a greater risk of developing other health complications including stroke, heart disease, osteoporosis and diabetes. To address this, Canadian guidelines recommend that HT patients should start a cardiac rehabilitation program within two months of their surgery.

A team of TRI researchers has found that HT recipients are referred for cardiac rehabilitation much later than what is recommended and that this delay is linked to a greater decline in the recipient’s body composition.

This retrospective study, led by Drs. Susan Marzolini (TRI Research Fellow) and Paul Oh (TRI Scientist), examined a group of 43 men and women who received a HT between 1996 and 2013. The researchers found that HT recipients were referred for rehabilitation 24.9 months after their surgery, which was 12 times longer than the time to referral observed in a comparable group of patients who had received another type of heart surgery. Moreover, the longer the delay to start the rehabilitation program, the greater a patient’s waist circumference, body mass index, hip circumference and body fat percentage upon starting their rehabilitation program, putting them at greater cardiovascular risk. However, once in the program, HT recipients experienced significant gains in their cardiovascular fitness.

“Additional research is required to determine the appropriateness of waiting so long to refer HT patients to a cardiac rehabilitation program and to elucidate the optimal exercise prescription strategies for these patients”, says Dr. Marzolini.                                              

This study was supported by the Toronto Rehab Foundation and the Ontario Ministry of Health and Long-Term Care.

Time-to-referral, use, and efficacy of cardiac rehabilitation after heart transplantation. Marzolini S, Grace SL, Brooks D, Corbett D, Mathur S, Bertelink R, Skeffington V, Alter D, Oh P. Transplantation. 2014 Aug 12 [Pubmed abstract]