Attendance at Cardiac Rehabilitation Is Associated With Lower All-Cause Mortality After 14 Years of Follow-Up

Study Questions:

Does cardiac rehabilitation (CR) independently predict long-term all-cause mortality, and is there is a dose–response relationship between the proportion of CR sessions attended and long-term mortality?

Methods:

This retrospective cohort study was conducted in CR programs in Victoria, Australia. The sample was comprised of 544 men and women eligible for CR following myocardial infarction, coronary artery bypass surgery, or percutaneous interventions. CR included 1 hour of education and 1 hour of low-to-moderate intensity exercise per session with duration of between 6 and 12 sessions. Participants were tracked 4 months after hospital discharge to ascertain CR attendance status. Main outcome measure was all-cause mortality at 14 years ascertained through linkage to the Australian National Death Index.

Results:

In total, 281 (52%) men and women attended at least one CR session. There were few significant differences between nonattenders and attenders. After adjustment for age, sex, diagnosis, employment, diabetes, and family history, the mortality risk for nonattenders was 58% greater than for attenders (hazard ratio, 1.58; 95% confidence interval [CI], 1.16-2.15). Participants who attended <25% of sessions had a mortality risk more than twice that of participants attending ≥75% of sessions (odds ratio [OR], 2.57; 95% CI, 1.04-6.38). This association was attenuated after adjusting for current smoking (OR, 2.06; 95% CI, 0.80-5.29).

Conclusions:

The study provides further evidence for the long-term benefits of CR in a contemporary, heterogeneous population.

Perspective:

As in this study of only 544 patients, the relationship between number of CR sessions and outcome has been shown in the US Medicare database (>200,000) with improved outcome from no sessions to 36 sessions; 36 being better than 24, 24 better than 18, etc. Of course persons who agree to participate in CR are more likely to be compliant with medication and lifestyle changes.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Smoking

Keywords: Outcome Assessment (Health Care), Myocardial Infarction, Life Style, Employment, Patient Discharge, Smoking, Heart Diseases, Australia, Cardiovascular Diseases, Confidence Intervals, Coronary Artery Bypass, Databases, Factual, Diabetes Mellitus


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