Skip to main content

Research Repository

Advanced Search

A randomised controlled, feasibility study to establish the acceptability of early outpatient review and early cardiac rehabilitation compared to standard practice after cardiac surgery and viability of a future large-scale trial (FARSTER)

Ngaage, Dumbor; Mitchell, Natasha; Dean, Alexandra; Mitchell, Alex; Hinde, Sebastian; Akowuah, Enoch; Doherty, Patrick; Nichols, Simon; Fairhurst, Caroline; Flemming, Kate; Hewitt, Catherine; Ingle, Lee; Watson, Judith


Dumbor Ngaage

Natasha Mitchell

Alexandra Dean

Alex Mitchell

Sebastian Hinde

Enoch Akowuah

Patrick Doherty

Simon Nichols

Caroline Fairhurst

Kate Flemming

Catherine Hewitt

Judith Watson


Objective: To determine the acceptability and feasibility of delivering early outpatient review following cardiac surgery and early cardiac rehabilitation (CR), compared to standard practice to establish if a future large-scale trial is achievable. Methods: A randomised controlled, feasibility trial with embedded health economic evaluation and qualitative interviews, recruited patients aged 18–80 years from two UK cardiac centres who had undergone elective or urgent cardiac surgery via a median sternotomy. Eligible, consenting participants were randomised 1:1 by a remote, centralised randomisation service to postoperative outpatient review 6weeks after hospital discharge, followed by CR commencement from 8 weeks (control), or postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention). The primary outcome measures related to trial feasibility including recruitment, retention, CR adherence, and acceptability to participants/staff. Secondary outcome measures included health-rated quality of life using EQ-5D-5L, NHS resource-use, Incremental Shuttle Walk Test (ISWT) distance, 30- and 90-day mortality, surgical site complications and hospital readmission rates. Results: Fifty participants were randomised (25 per group) and 92% declared fit for CR. Participant retention at final follow-up was 74%; completion rates for outcome data time points ranged from 28 to 92% for ISWT and 68 to 94% for follow-up questionnaires. At each time point, the mean ISWT distance walked was greater in the intervention group compared to the control. Mean utility scores increased from baseline to final follow-up by 0.202 for the intervention (0.188 control). Total costs were £1519 for the intervention (£2043 control). Fifteen participants and a research nurse were interviewed. Many control participants felt their outpatient review and CR could have happened sooner; intervention participants felt the timing was right. The research nurse found obtaining consent for willing patients challenging due to discharge timings. Conclusion: Recruitment and retention rates showed that it would be feasible to undertake a full-scale trial subject to some modifications to maximise recruitment. Lower than expected recruitment and issues with one of the clinical tests were limitations of the study. Most study procedures proved feasible and acceptable to participants, and professionals delivering early CR. Trial registration: ISRCTN80441309 (prospectively registered on 24/01/2019).


Ngaage, D., Mitchell, N., Dean, A., Mitchell, A., Hinde, S., Akowuah, E., …Watson, J. (2023). A randomised controlled, feasibility study to establish the acceptability of early outpatient review and early cardiac rehabilitation compared to standard practice after cardiac surgery and viability of a future large-scale trial (FARSTER). Pilot and Feasibility Studies, 9(1), Article 79.

Journal Article Type Article
Acceptance Date Apr 21, 2023
Online Publication Date May 11, 2023
Publication Date Dec 1, 2023
Deposit Date Apr 24, 2023
Publicly Available Date May 12, 2023
Journal Pilot and Feasibility Studies
Electronic ISSN 2055-5784
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 9
Issue 1
Article Number 79
Keywords Cardiac surgery; Cardiac rehabilitation; Outpatient review; Feasibility; Median sternotomy
Public URL


Published article (1.4 Mb)

Publisher Licence URL

Copyright Statement
© Crown 2023.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

You might also like

Downloadable Citations