Comorbidity in patients undergoing coronary artery bypass graft surgery: impact on outcome and implications for cardiac rehabilitation

The increasing comorbid disease burden among patients undergoing coronary artery bypass graft surgery (CABG) and the improved operative survival are expanding the number of post-CABG patients living with prognostically significant comorbidities. In a large contemporary database, 29.9% of the patients receiving isolated CABG had diabetes mellitus, 16% peripheral vascular disease, 18.6% chronic obstructive pulmonary disease, and 27.5% renal dysfunction. Patients with comorbidity are more likely to be old and often female, may have special care-requirements early after discharge, and are at increased risk for adverse outcomes. Contemporary available evidence indicates that older individuals, women, and patients with comorbidities are significantly less likely to receive cardiac rehabilitation. In addition, compliance with proven atherosclerosis risk reduction strategies for CABG patients is suboptimal. In this article we will review the impact of comorbidity on short-term and long-term outcome after CABG and their implications for cardiac rehabilitation.