Title: Prehabilitation before cardiac surgery in the UK (CARDIAC PREHAB-UK)
Funder: Department of Health and Social Care

Abstract: BACKGROUND Prehabilitation is the process of enhancing an individual's functional capacity, usually with exercise and nutritional support, sometimes also with psychological and educational components, to enable them to withstand a forthcoming stressor such as major surgery. There is currently no prehabilitation programme for cardiac surgery patients in the UK. AIMS AND OBJECTIVES The overall aims of this Development Grant is to undertake preparatory work to inform the future design, delivery and testing of two prehabilitation interventions in the urgent and elective care pathways in cardiac surgery (future Programme). The objectives are to: Define current preoperative assessment practice (screening, interventions, models of care) in the UK. Characterise the cardiac surgery population (demography, co-morbidities, deprivation profiles) in the UK. Assemble a patient advisory group (PAG) representative of the cardiac surgery population with respect to demographics, ethnic group and deprivation profiles. Assemble a stakeholder group and conduct a meeting to identify areas of uncertainty to guide a scoping review. Conduct a scoping review addressing the uncertainties identified by the stakeholder group and PAG. Conduct a second meeting with the stakeholder group to consider the evidence from the scoping review and produce guiding principles for prehabilitation in urgent and elective pathways. DEVELOPMENT WORK PLAN The Development Grant will be divided into six developmental work packages (DWPs): DWP1: Telephone or online survey with healthcare professionals delivering perioperative care (surgeons, anaesthetists and nurses) and hospital managers in the 31 UK cardiac surgery centres to gather information about usual patient pathways, screening for co-morbidities, risk stratification, additional diagnostic tests, referrals, etc. DWP2: Analysis of routinely collected data (National Adult Cardiac Surgery Audit and Hospital Episode Data) to describe patient characteristics (including socioeconomic deprivation), overall and by centre, for all cardiac surgery procedures. DWP3: Assembly of a patient advisory group (PAG) representative of the cardiac surgery population characterised in DWP2. The group will include patients who have had surgery, are waiting to have surgery as well as their carers. PAG views and needs about prehabilitation will inform DWP4-DWP6. DWP4: Assembly of a stakeholder group (clinicians, prehabilitation experts, PAG members) to convene in a one day meeting to consider uncertainties that exist with regards to applicability of current prehabilitaton guidance to cardiac surgery; cardiac-surgery specific prehabilitation components; implementation in urgent and elective pathways. DWP5: A scoping review, following standard methodological framework, to address uncertainties identified in DWP4. DWP6: A second stakeholder group meeting to consider the evidence from DWP5 and produce guiding principles for prehabilitation in urgent and elective cardiac surgery patients. TIMELINES FOR DELIVERY 16 month project. DWP1 and DWP2: months 1-3; DWP3: months 3-4; DWP4: months 2-5; DWP5: months 6-13; DWP6: month 14; dissemination and report to funder: months 15-16. ANTICIPATED IMPACT AND DISSEMINATION The study findings will be presented to the healthcare community via professional associations, on the study team s website and via social media. We will publish a lay summary. Our patients group will be central to getting the message out in an easily understood way, to patients, carers and the wider public.

Lay abstract: BACKGROUND TO THE PROJECT About 34,000 people have heart operations every year in the UK. More than half experience complications after their operation, which delay recovery and increase hospital stay, reducing quality of life and increasing costs for the NHS. Prehabilitation (Prehab) is a way of making patients fitter before their operation with exercise, dietary advice, education and psychological support. Prehab improves patients physical and mental wellbeing, reducing complications and speeding up recovery. We currently have Prehab guidance for patients who are having operations to treat cancer but not patients who have operations to treat heart disease. AIMS OF THE RESEARCH Our research (future Programme Grant) will design a Prehab programme to support patients undergoing heart operations and test whether it can be introduced in the NHS and whether it works, but first we need to spend some time exploring and reviewing the best way to get this done (Development Grant). WORK PLAN The Development Grant is divided into six specific Developmental Work Packages (DWPs). We will: DWP1: Conduct a survey online or by phone with all 31 UK heart surgery centres to find out how they prepare patients for their operation; this will allow us to understand the existing system better. DWP2: Analyse routine NHS patient health data to describe the types of patients who have heart operations in terms of age, gender, ethnic group, socio-economic status, other conditions; this will allow us to identify their Prehab needs. DWP3: Create a patient advisory group (PAG) including the types of patients characterised in DWP2 to get a better understanding of patients needs and views about Prehab. DWP4: Bring together a group of heart doctors and Prehab experts and host a meeting to discuss the findings from DWP1-DWP3 and consider what type of Prehab is needed for different patients. DWP5: Use the findings from DWP4 to guide a review of all existing research articles and materials to inform the design of the future Prehab programme. DWP6: Host a second meeting with the expert group from DWP4 to consider the evidence from the review and produce guiding principles for how we should develop and test the Prehab programme. PATIENT AND PUBLIC INVOLVEMENT (PPI) The idea for this research came from patients who participated in the National Heart Surgery Research Priority Setting Partnership. Our PPI co-applicants will lead DWP3 to ensure that patients are involved in all the development stages of the Prehab programme. DISSEMINATION AND ANTICIPATED RESULTS We will work with our PPI co-applicants and PAG to co-produce and communicate the findings from this work, which will be used to develop the Prehab programme for heart surgery patients and its introduction and testing in NHS hospitals in the future Programme Grant.

Research activity codes: 5.4 SURGERY
Health categories: CARDIOVASCULAR