From Court to Couch: Exercise and Quality of Life after Acute Type A Aortic Dissection

Background Acute Type A aortic dissection can be physically and mentally stressful with little known about survivors' postrepair activity levels, exercise habits, and quality of life (QOL). This study was aimed to describe pre- and postdissection changes regarding exercise, understand physician recommendations, quantify use of cardiac rehabilitation, and assess QOL in dissection survivors. Methods A total of 295 acute Type A aortic dissection survivors were surveyed about exercise, cardiac rehabilitation, QOL, sexual activity, and posttraumatic stress disorder (PTSD) with 137 (46%) respondents. Results Respondents were less likely to participate in competitive athletics after than before dissection (1/131 [0.76%] vs. 26/131 [20%], p [McNemar test] < 0.0001) or lift heavy objects (11/111 [9.9%] vs. 41/111 [37%], p < 0.0001). Forty-eight of 132 respondents (36%) did not participate in cardiac rehabilitation. Compared with general population norms, respondents reported lower median QOL physical component scores (40 [26, 51; 15th, 85th percentile], p < 0.0001); these were lower in respondents who did not exercise (Hodges–Lehmann [HL; 95% confidence interval (CI)]: –6.8 [–11, –2.4], p = 0.002), limited sexual activity (–8.0 [–13, –4.3], p = 0.0002), or screened positive for PTSD (–10 [–14, –5.3], p = 0.0002). Median mental component scores were similar to general population norms (HL [95% CI]: 55 [34, 61], p = 0.24) but were lower among respondents who did not exercise (–4.2 [–7.8, –1.0], p = 0.01), limited sexual activity (–5.5 [–10, –1.8], p = 0.003), or screened positive for PTSD (–16 [–22, –10], p < 0.0001). Conclusion Physicians should prescribe cardiac rehabilitation, encourage appropriate exercise, promote resumption of sexual activity, and identify and treat PTSD after surgery for acute Type A aortic dissection.