Abstract 17819: Long-term Outcomes After Cardiac Rehabilitation: Impact of a Disease Management System on Survival

Abstract

Introduction: Prior studies have identified the benefits of a disease management system (DMS) in coronary artery disease (CAD) prevention, and we have published data showing favorable results on 3-year surrogate outcomes with DMS after cardiac rehabilitation. Hypothesis: Long-term survival in patients with CAD after cardiac rehabilitation is improved by participation in a DMS for at least 3 years post-event.

Methods: We followed 503 patients enrolled consecutively in Phase II cardiac rehabilitation after an acute coronary event in 1999-2000 until 4-26-2012. Patients had the option to enroll in the DMS to be seen in follow up every 3-6 months for assessment of secondary prevention goals. Control of blood pressure and lipids, smoking cessation, dietary counseling, and exercise prescription were provided. We assessed survival by participation in DMS for at least 3-years post-event using Cox proportional hazards regression controlling for age, sex, and other factors associated with mortality.

Results: 12 patients died within the first 3 years and were excluded. Demographics of patients analyzed included women 25%, diabetes 21%, hypertension 48%, and tobacco use at the time of the index event 17%. Age at enrollment was 66 ± 12 years. 335 (68%) participated at least 3 years in DMS whereas 156 (32%) opted out of the DMS or dropped out before 3 years. Patients with increased mortality included those with advanced age (hazard ratio (HR) = 1.10, p< 0.0001) and diabetes (HR = 2.22, p< 0.0001); there were no significant differences between DMS participants and non-participants on these variables or type of index event (MI, PCI, or CABG). Controlling for these predictors as well as gender, mortality was significantly decreased in the DMS group with HR = 0.69 [95% CI 0.493-0.967, p = 0.0312].

Conclusion: We found a long-term survival benefit for participation in a DMS after cardiac rehabilitation during an average follow-up of 11 years after the index cardiac event.