Effect of Phase I Cardiac Rehabilitation on Cardiac Delirium after Aortic Valve Replacement

Background:Patients underwent aortic valve replacement (AVR), particularly the elderly, are at increased risk of developing delirium during hospitalization. Delirium following surgical and transcatheter AVR (SAVR and TAVR) has been associated with poorer functional outcomes, increased hospitalization days and reduced long-term survival. Objective: This study aimed to identify the effect of phase-I cardiac rehabilitation (CR) on the incidence and severity of delirium following AVR. Patients and methods: Sixty patients with AVR of both sexes with age ranged from 60 to 70 years old were selected from the Intensive Care Unit (ICU) and Cardiac Care Unit (CCU) of the National Heart Institute and Kasr El Ainy Hospital and were randomly assigned into two equal groups (n=30 each). Group (A) received phase-I CR for 20 minutes daily. Group (B) received breathing and circulatory exercises for 20 minutes, three times per day, in addition to optimal medical therapy, until discharge. Results: Age, sex distribution, weight, height, body mass index (BMI), HbA1c, platelet-to-white blood cell ratio (PWR), and cardiac index were not significantly different between the two groups at baseline (P > 0.05). The mean duration of hospitalization was significantly shorter for group A (5.83 ± 1.05 days) compared to group B (11.57 ± 1.91 days), with a mean difference of -5.73 days (95% CI: -6.53 to -4.94; p < 0.001; ES=-3.72). The pre-operative and pre-treatment CAM scores did not exhibit a significant difference between the groups (P = 1.000 and P = 0.587, respectively). Nevertheless, the CAM scores in group A were markedly lower than those in group B after treatment (0.00 vs. 1.00; P < 0.001; effect size [ES] = -0.78). In the same vein, Group A's post-treatment RASS scores were substantially higher (0.00 vs. -1.00; P = 0.030; ES = -0.28), suggesting that arousal and responsiveness increased. Conclusion: It could be concluded that phase-I CR significantly reduced the severity of delirium and improved sedation-agitation levels in patients following AVR compared to standard breathing and circulatory exercises.