Patients undergoing heart surgery often face risk factors such as smoking and lack of physical activity. Currently, these issues are mainly addressed after surgery during cardiac rehabilitation. However, research shows that lifestyle interventions before surgery lead to better recovery and fewer complications. To integrate this approach into standard care, a large-scale cost-effectiveness study is essential.

The DCVA Project Group Eerder Beter is committed to making preoperative lifestyle interventions accessible to vulnerable patients. By using the waiting period as an active preparation phase, patients can enter and exit surgery in better condition. We aim to implement this approach on a national scale and evaluate its effectiveness both scientifically and practically, including for cost-effectiveness.

Collaboration to this end is crucial. The goal is to bring the already-ongoing initiatives together (where possible) and accelerate on a national scale. To do so, brainstorm meetings were held in March and September 2024. The diverse group attendents, with different insights and expertise, spoke about the possibility of setting up a national study on prehabilitation for patients undergoing cardiac surgery and the considerations to be taken. Following these meetings, the project group started developing a research proposal, carefully incorporating all considerations discussed.

Significant variation exists among hospitals regarding perioperative care pathways, including waiting times, patient interactions, and provided information. To address this, we are conducting preparatory work, partially funded by recent grants:

• Coalitie Leefstijl in de Zorg is funding a blueprint for peri-operative care pathways to optimize lifestyle interventions, based on the handout "Teachable moments".
• The DCVA-WCN Pitch award secured funding to develop a roadmap for implementing cardiac rehabilitation before surgery.

We will work with the different Dutch heart centers to map variations in care, provide recommendations, and finalize the design of the national cost-effectiveness study. These initiatives will support the further development and implementation of this innovative approach. We look forward to collaborating with partners to advance cardiac care.

For more information or to get involved, contact us at info@dcvalliance.nl