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Ambulatory Cardiac Rehab and CV Outcomes
Study Questions:
Is ambulatory cardiac rehabilitation (CR) associated with improved clinical outcomes in a real-world population?
Methods:
Data from two tertiary hospitals were used for the present analysis. One hospital system referred all patients discharged with the following diagnosis (ST-segment elevation myocardial infarction [STEMI], non-STEMI, coronary artery bypass grafting, or planned percutaneous coronary intervention [PCI]) to an ambulatory CR program. The first scheduled CR visit was provided at time of discharge. In the other hospital, no CR was provided. All consecutive patients between January 1, 2009 and December 31, 2010 were included. Five-year follow-up for cardiovascular (CV) mortality, all-cause mortality, and CV hospitalizations were collected in CR attenders and nonattenders.
Results:
A total of 839 patients attended the CR program and 441 patients were discharged from the hospital without any CR program. Compared with those who did not attend the CR program, attenders were more likely to be female, and were older with more prevalence of risk factors and comorbidities such as hypertension, smoking, dyslipidemia, and chronic renal failure. Attenders presented less often with a history of prior acute coronary syndrome or PCI. During follow-up, the incidence of CV mortality was 6% in both groups (p = 0.62). The composite outcome of hospitalizations for CV causes and CV mortality were lower in the CR group compared to the no-CR group (18% vs. 30%, p < 0.001). This difference was accounted for mainly by lower hospitalizations for CV causes (15% vs. 27%, p < 0.001). After adjustment for potential confounders, participation in CR was an independent predictor of lower occurrence of the composite outcome (hazard ratio, 0.58; 95% confidence interval, 0.43-0.77; p < 0.001) in the propensity-matched analysis. The CR group also experienced a lower total mortality (10% vs. 19%, p = 0.002) and CV mortality (2% vs. 7%, p = 0.008) compared with the no-CR group.
Conclusions:
The investigators concluded that in a real-world population, ambulatory CR was associated with improved clinical outcomes including reduced CV hospitalizations and CV mortality during a long-term follow-up.
Perspective:
These real-world data support the participation in CR for patients following discharge for a cardiac condition. Although attenders and nonattenders were not randomized, from different hospital systems and with different clinical characteristics, the investigators used propensity matching to balance the two groups as much as possible. Given that eligibility criteria of randomized clinical trials may not provide information on certain patients, data such as those presented in this study assist in furthering understanding of interventions such as CR.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and ACS, Hypertension, Smoking
Keywords: Acute Coronary Syndrome, Cardiac Rehabilitation, Coronary Artery Bypass, Dyslipidemias, Hypertension, Kidney Failure, Chronic, Myocardial Infarction, Patient Discharge, Percutaneous Coronary Intervention, Primary Prevention, Renal Insufficiency, Chronic, Risk Factors, Smoking, Tertiary Care Centers
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