Inpatient Prehab Restores Heart Transplant Eligibility
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- Radha Gopalan, a heart transplant cardiologist at Banner–University Medical Center Phoenix, launched an inpatient cardiac prehab program in 2023 targeting patients on the transplant waitlist who were hospitalized for worsening heart failure, abnormal heart rhythms, or coronary artery disease.
- Gopalan's team reported results for 45 patients in April at the International Society of Heart and Lung Transplantation meeting in Toronto: 56% of pretransplant patients in year one and 62% in year two met transplant listing criteria after improvement, with no reported adverse events including no falls or deaths.
- Patients entered the program with an average frailty score of 2.5 out of 5 and improved to 1.5 — Gopalan's team considers a score of 3 or higher a disqualifying high-risk cutoff for postoperative complications, meaning every participant started as 'not qualified' for immediate transplant.
- The prehab gym is equipped with a recumbent bicycle, a sit-down bicycle, and an arm-only bicycle; a treadmill was deliberately excluded to eliminate fall risk on the telemetry floor where the program operates.
- Funding comes from philanthropy secured through the hospital's foundation after Gopalan proposed the arrangement: he would provide the money, the hospital would provide the space. He said NIH grant applications would require collecting more data first.
- The motivation was straightforward, per Gopalan: research shows one day of bed rest costs three days of muscle-strength recovery, so a 10-day hospital stay sets a patient back roughly a month — enough for some to develop complications and never qualify for transplant at all.
Why it matters: Gopalan's program targets a specific, costly failure mode: patients losing transplant eligibility during inpatient waits due to bed rest-induced frailty. With 45 patients treated and roughly 6 in 10 achieving listing criteria, the model demonstrates a safe, equipment-light intervention (bikes only, no treadmill) that could expand the viable transplant candidate pool. Currently funded by philanthropy rather than NIH grants, the approach's broader adoption hinges on the additional data Gopalan says is still needed.
