Diabetic Cardiac Patients and Their Obvious Need For Intensive Cardiac Rehabilitation
Bharathi Reddy M.D., Keosik Lee M.S. R.C.E.P., Nancy Rullo, M.S. M.A., Donna Cheslik, R.N., M.S.N., John Nicholson, M.D
Background: Diabetes is an established and highly prevalent risk factor for cardiac morbidity and mortality. Diabetic patients in particular have high risk for cardiac mortality and morbidity compared to non-diabetic patients. We speculate that diabetic cardiac patients need a more intensive and focused cardiac rehabilitation program.
Objective: The purpose of this retrospective observational study was to determine if patients with diabetes enrolled in Cardiac Rehabilitation Program at New York Hospital Queens
achieved an equal functional capacity compared to non-diabetic patients.
Methods: Retrospective analysis on 174 patients with and with out diabetes, age (68.13+ 6.16) completed a twelve week cardiac rehabilitation (CR) program at Cardiac Health Center. Exercise tests were performed on all patients’ pre and post CR utilizing standard Bruce protocol.
Results: Of 174 patients, 21 are with diabetes (17 males and 4 females) 153 are with out diabetes (115 males, 38 females). In diabetes group, patients diagnosed with 4.8% angina, 66.7% CABG, 4.8% MI, 23.8% PTCA. In non diabetic group, pts diagnosed with 6.4% angina, 48.2% CABG, 5.0% MI, 37.6% PTCA and 2.8% has other cardiac conditions. Paired t testing revealed similar improvement post – CR MET levels in both groups; diabetes group (5.9+1.6METS to 7.1+1.6METS p<0.05) non-diabetes group (5.6+1.7METS to 6.9+1.8METS p<0.05). Baseline exercise capacity was similar in both groups. Further analysis revealed that patients with diabetes post-CABG demonstrated significantly less improvement in exercise capacity compared to patients without diabetes post-CABG after CR. Post exercise stress testing on patients with diabetes post CABG showed an overall 16% improvement in functional capacity as compared to 23.6% improvement in non diabetic patients post CABG (p< 0.05).
Conclusion: All diabetic patients with coronary artery disease showed similar improvement in functional capacity after CR except for post-CABG. This emphasizes the need to identify Diabetic post-CABG patients in contemporary cardiac rehabilitation programs and target them for an aggressive program of risk factor management focusing on more effective interventions in weight management, lipid lowering, glycolic control, patient’s compliance along with exercise training. Literature review suggests that diabetic post-CABG has higher incidence of depression, recurrent cardiac events with longer hospital stay. Therefore a comprehensive cardiovascular risk reduction therapy is advantageous for post - CABG diabetic patients.