Heart surgery patients typically wait six weeks for a follow-up review and eight weeks to start cardiac rehabilitation—but a new trial will test whether shifting that timeline forward by three weeks leads to faster recovery and lower NHS costs. This matters because the current standard schedule is based on tradition, not evidence. A smaller feasibility study suggested that earlier review at three weeks and rehabilitation at four weeks improved physical recovery and was preferred by patients. The new trial will recruit 588 patients across 16 UK centres, randomly assigning them to either standard care or the accelerated pathway. The primary measure is change in walking capacity six months after randomisation, assessed by the incremental shuttle walk test. If the accelerated pathway proves superior, it could reshape post-surgery care across the NHS—shortening recovery time, reducing hospital readmissions, and saving money. The findings will be shared with the British Heart Foundation and cardiac rehabilitation professional bodies to inform national guidelines. The trial runs for 48 months, with results expected to influence clinical practice directly.
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Research Question: Will conducting patient review and cardiac rehabilitation (CR) earlier than in standard care after sternotomy lead to improvements in patient outcomes which are cost-effective? Background: Standard care after heart surgery with sternotomy involves patient review 6 weeks after hospital discharge followed by cardiac rehabilitation (CR) from 8 weeks. This practice is not supported by research evidence. However, our NIHR-funded multi-centre feasibility study (FARSTER) showed that patient review at 3 weeks followed by CR from 4 weeks, could lead to faster and better recovery of physical functional capacity, be more cost effective and was preferred by patients. Aims and Objectives: We propose a fully powered multicentre RCT to determine if early specialist review and CR will lead to improved outcomes and cost effectiveness compared to standard care. Our primary objective is to assess change in physical functional capacity using incremental shuttle walk test (ISWT) at 6 months after randomisation, for patients who have earlier CR compared to those who receive standard care. The secondary objectives are to compare: i) Performance for PROM-CR (a patient reported outcome measure designed and validated for CR) at pre-CR, post-CR, and 6 months post randomisation. ii) Change in patient reported health related quality of life, measured using EQ-5D-5L. iii) NHS resource consumption, including the associated cost implications. iv) CR uptake, compliance and completion. v) Impact of face-to-face or remote modes of specialist review and CR delivery, on CR programmes. vi) Adverse outcomes including 30- and 90-day mortality, sternal wound complications, hospital attendance/readmission. vii) Health economic analysis to evaluate the within-trial and long-term cost effectiveness of the intervention. viii) Patient-reported anxiety levels using Generalised Anxiety Disorder (GAD-7) questionnaire. Methods: We will recruit 588 cardiac surgery patients who have had a sternotomy at 16 UK centres over 2 years, and randomise 1:1 to standard care (control) or intervention arms. Intervention arm will have specialist review 3 weeks, and control arm 6 weeks, after hospital discharge; patients certified fit for CR will start a comprehensive, individualised programme at 4 weeks for intervention, and 8 weeks for control arms. Exercise will be prescribed according to standards published by the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) and Association of Chartered Physiotherapists in Cardiac Rehabilitation (ACPCR), performed weekly for eight weeks as usual for the recruiting site, either; centre-based, home-based or hybrid. At the start and end of CR, patients will undergo functional assessment at recruiting sites using ISWT and complete a PROM-CR questionnaire; and again at 6 months. Follow-up data will include; health-resource use and EQ-5D-5L questionnaires at 6 and 12 months, 30- and 90-day mortality, hospital readmissions and reinterventions. Timelines for delivery: Study duration is 48 months; 6 for regulatory approvals and trial/site set up, 24-month recruitment phase, 12 to complete CR and follow-up, and 6 for analyses and write-up. Anticipated impact and dissemination: This study has the potential to effect positive change in clinical practice. We will report our results to our funder, PPI group, and clinicians, and share our findings with the British Heart Foundation, BACPR and ACPCR to inform practice guidelines.
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