Abstract 17133: Cardiac Rehabilitation and Long-Term Outcome after Myocardial Infarction. Real-World Data from the French FAST-MI 2005 Registry
Background and aim: Prospective trials have yielded conflicting results on the survival impact of rehabilitation after AMI. Little is known, however, of the association between use of cardiac rehabilitation and long-term outcome in a contemporary real-world setting. We assessed 5-year mortality in AMI patients included in the FAST-MI registry at the end of 2005, according to the use of rehabilitation after hospital discharge.
Methods: FAST-MI is a French nationwide registry of patients hospitalized within 48 hours of STEMI or NSTEMI, at the end of 2005 in 223 institutions representing 60% of all French institutions taking care of AMI patients. Of the 3,670 patients included, 3,463 were discharged alive, of whom 752 (22%) were scheduled for in-patient or out-patient rehabilitation (Rehab+).
Results: Rehab + patients differed from those without rehabilitation (Rehab-) in many respects; in particular they were younger (63±14 vs 68±14 years), and had less frequent previous Hx of CAD (23% vs 33%). The index event was more often a STEMI (66% vs 46%) and LVEF was similar in the 2 groups (52% vs 53%). Among patients not receiving the totality of recommended medical therapy at discharge, Rehab+ patients received full treatment at 1 year more often than Rehab- patients (37% vs 27%, P=0.003). Five-year mortality was lower in Rehab+ pts (16% vs 28%, P<0.001). The HR for 5-year death, adjusted for age, sex, clinical profile, medical history, in-hospital treatment and complications, and discharge medications was 0.74 (95%CI: 0.61-0.91; P=0.004). Compared with Rehab-, the HR for 5-year death was 0.87 (95%CI 0.68-1.12) for in-hospital rehabilitation, while that of out-patient rehabilitation was 0.60 (0.44-0.82). In propensity-score adjusted cohorts (n=575), however, 5-year survival was not significantly different in Rehab+ (84.5%) and Rehab- (81%) patients (HR=0.80, 95%CI 0.60-1.06; P=0.12).
Conclusion: in this real-world nationwide registry, rehabilitation was used more often in younger patients and in STEMI patients. Post-MI rehabilitation was associated with improved medical treatment one year after the index event and with higher 5-year survival.
- © 2012 by American Heart Association, Inc.