Health Sciences
A multi-centre randomised controlled trial of standard care versus an accelerated care pathway after cardiac surgery (FARSTER-Care)
In the UK, heart operations have steadily increased since 2010, and 36,166 heart operations were performed in 2016. Following cardiac surgery, patients currently attend their first outpatient review six weeks after hospital discharge, where recovery is assessed and fitness to commence cardiac rehabilitation (CR) is determined. CR is then started from eight weeks.
The long interval before postoperative review and CR extends the period of vulnerability and inactivity for patients, with patients often seeking medical attention for surgery-related complications during this period. In a prospective observational study, we found that 38.9% of patients sought further medical help during this 6-week period, and 44.4% would like an earlier review.
Our randomised control trial aims to determine if early CR leads to improved outcomes and is cost-effective compared to standard CR. Including an 8-month internal pilot to obtain robust estimates of recruitment and retention ensuring trial viability, we aim to recruit 588 cardiac surgery participants (over 24 months) who have had a full median sternotomy at UK centres and will randomise participants 1:1 to control (standard care) or intervention arms. Participants in the control arm will receive standard post-sternotomy cardiac surgery care which includes specialist review at six weeks after hospital discharge, followed by commencement of CR from eight weeks. Participants in the intervention arm will have a specialist review at three weeks after hospital discharge, followed by the commencement of CR from four weeks.
Both groups will receive a pre-CR assessment then eight weeks of CR, followed by a post-CR review. In addition, there will be follow-up appointments for both groups at six months post-randomisation, and a final questionnaire at 12 months post-randomisation. The outcome will be measured through a variety of standard clinical tests (e.g., incremental shuttle walk test) as well as questionnaires
including PROM-CR, EQ-5D-5L, GAD-7 and resource use questions.
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Funding
| Funders(s) | NIHR Health Technology Assessment Programme: NIHR152069 |
|---|---|
| Start Date | July 2023 |
| End Date | June 2027 |
Members
YTU Team
- Jude Watson
- Natasha Mitchell
- Caroline Fairhurst
- Alex Mitchell
- Grace O’Carroll
- Radwa Abdelatif
- Jessica Goodliffe
External
- Dumbor Ngaage, Chief Investigator, Hull University Teaching Hospitals NHS Trust
- Enoch Akowuah, South Tees Hospitals NHS Foundation Trust
- Laura Selke, Hull University Teaching Hospitals NHS Trust
- Mrs Barbara Mendham, Patient and Public Involvement co-applicant
- Andrew Frost, Patient and Public Involvement co-applicant
- Patrick Docherty, Department of Health Sciences, University of York
- Seb Hinde, Centre for Health Economics, University of York
