Abstract 9033: Cardiac Rehabilitation is Associated With Especially Improved Outcomes in Women and the Elderly: Results From a Large Cohort Study of Coronary Artery Disease Patients
Background: Survival from acute coronary syndromes has improved in recent decades and attention is now focusing on reducing recurrent events in coronary artery disease (CAD) patients. Cardiac Rehabilitation (CR) is an important part of this secondary event prevention but it is underutilized, especially in high-risk groups. Hypothesis: CR will reduce resource utilization and mortality in subjects with CAD, particularly for women and the elderly.
Methods: We conducted a retrospective cohort study of 5901 subjects referred for CR in Calgary, Canada between 1996 and 2009. Data was obtained from the Cardiac Wellness Institute of Calgary and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease databases. Baseline characteristics were compared between CR attendees and non-attendees. Outcomes of interest were freedom from emergency room visits, hospitalization and survival in CR attendees vs. non-attendees. Cox regression models were constructed to determine Hazard ratio (HR) for events in CR attendees vs. non, stratified by age and sex, adjusted for clinical covariates, treatment strategy and coronary anatomy.
Results: Of 5901 subjects, 2900 attended CR. Subjects who attended CR were younger, more likely to be male, and had a lower burden of co-morbidities (all p-values<0.01). CR attendance was associated with a decreased risk of ER visits and hospitalization at 3 years [adjusted HR, 0.89 (95% CI 0.82 to 0.96) and 0.78 (95% CI 0.71 to 0.85), respectively]. CR was associated with a lower risk of death, with an adjusted HR of 0.59 (95% CI 0.49 to 0.70). CR had a greater impact on mortality in women (HR 0.40, 95% CI 0.25 to 0.64) than men (HR 0.64, 95% CI 0.53 to 0.78), and in the elderly (HR 0.50, 95% CI 0.34 to 0.74) than the non-elderly (HR 0.62, 95% CI 0.51 to 0.77).
Conclusions: In this CAD population, we observed that CR attendance is associated with reductions in mortality and resource utilization (ER visits, hospitalization). These findings were particularly striking for two high-risk groups, women and the elderly. Given the clinical benefits and resource utilization improvements that may be realized through CR, attention should be placed on referring all eligible subjects to CR and addressing barriers to attendance.
- © 2010 by American Heart Association, Inc.