Abstract 11349: Cardiac Rehabilitation Following Cardiac Surgery: Patient Characteristics, Participation Rate and Outcomes
Background: Though cardiac rehabilitation (CR) is underused in the coronary artery disease (CAD) population, cardiac surgery has been demonstrated to be a predictor of CR attendance. The objective of this study was to determine referral characteristics and the impact of CR on outcomes in patients who have undergone coronary artery bypass grafting (CABG).
Methods: Our study included 1348 subjects who underwent CABG and were referred for CR 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. The outcomes of interest were survival, freedom from hospitalization and emergency room (ER) visits, unadjusted and then adjusted for clinical covariates and coronary anatomy. Cox regression models were constructed to determine the hazard ratio (HR) for events in those who participated in CR vs. those who did not. A propensity model to predict CR attendance was then constructed and a propensity matched analysis undertaken.
Results: Of those referred, 752 attended CR (56%). Those who attended were more likely to be male, younger, and without diabetes (all p-values <0.01). CR attendance was associated with a lower risk of mortality, hospitalization, and ER visits in the unadjusted models (HRs of 0.53 (95%CI 0.40, 0.70), 0.84 (95%CI 0.72, 0.98) and 0.86 (95%CI 0.74, 1.00). In adjusted models, CR attendance remained associated with decreased mortality (HR, 0.62 (95%CI 0.47, 0.83)), but associations with hospitalization and ER visits were not significant. In the propensity matched analysis, CR attendance was associated with decreased mortality (HR 0.70 (95%CI 0.53, 0.94)), and a trend towards decreased hospitalization and ER visits.
Conclusions: In this cohort of CABG patients, we observed that CR attendance was associated with decreased mortality and a trend towards decreased hospitalization and ER visits. While CR attendance in cardiac surgery patients is better than other CAD patients, substantially greater participation is desirable to maximize potential clinical improvements.
- © 2011 by American Heart Association, Inc.