Abstract 10781: Association Between Cardiac Rehabilitation and Mortality and Rehospitalization Following Acute Myocardial Infarction
Background: Cardiac rehabilitation (CR) has previously been shown to reduce mortality and morbidity. As acute and chronic treatments for acute myocardial infarction (AMI) have improved over time, the benefits of CR may also have changed. Accordingly, we examined the association between CR and all-cause mortality and rehospitalization in a large contemporary cohort of post-AMI patients.
Methodology: Among 6,838 patients enrolled in 2 US multi-center, prospective registries of AMI patients (PREMIER and TRIUMPH), 2499 were referred to CR. We derived a propensity-matched cohort allowing up to a 1:2 match of patients referred to CR who did or did not attend 1 or more CR sessions by the time of their 6 month follow-up interview (n=1,647; 719 in the CR group and 928 in the no CR group). More than 60 variables were used in the matching, including patient demographics, socioeconomic factors, medical history, disease severity, treatment, psychological factors, quality of life, and physical function. The primary outcomes were all-cause death at eighteen months after discharge and rehospitalization within 12 months of discharge (time of last scheduled follow-up).
Results: Baseline characteristics were well matched between the groups, except patients not attending CR had higher Killip Class on admission and lower education. These unmatched variables were included as separate covariates in the risk-adjusted models. After multivariable adjustment, there was lower all-cause mortality in the CR group (1.1% vs. 3.7%; HR 0.42, 95% CI 0.18-1.00). Adjudicated rehospitalization rates (available in the TRIUMPH registry only) were not statistically different for those who did vs. did not attend CR (14.4% vs. 12.6%; HR 0.93, 95% CI 0.52-1.67).
Conclusions: Participation in CR was associated with lower 18-month mortality as compared with those not attending CR at 18 months in this contemporary cohort of AMI patients. However, CR attendance was not associated with rehospitalization risk. These findings highlight the importance of CR as an integral part of secondary prevention in reducing mortality and underscore the importance of developing systems to encourage participation in CR.
- © 2011 by American Heart Association, Inc.