Abstract 16280: Use and Effectiveness of Cardiac Rehabilitation Programs Among Patients Referred After Acute Myocardial Infarction
Background: Guidelines recommend cardiac rehabilitation after acute myocardial infarction (MI), yet little is known about contemporary participation rates and whether longer participation continues to provide incremental benefit particularly among older adults.
Methods: We linked 40,347 patients 65 years or older referred to cardiac rehabilitation after acute MI in the ACTION Registry-GWTG from Jan 2007 to Dec 2010 to Medicare claims data to examine 1-year mortality. We used multivariable Cox regression to compare mortality among cardiac rehab participants stratified by number of sessions completed as a continuous, time-dependent variable.
Results: Overall, 13,116 patients (32.5% of referred) participated in cardiac rehabilitation post-MI. Of those participating, the median number of rehab sessions completed was 26 (IQR 14-35). Those who completed >26 sessions were more likely male (65% vs. 61%), and had slightly fewer comorbidities (Charlson index >3 in 18% vs. 21%). Factors such as age (median 73 yrs), race (6% non-white), rates of STEMI reperfusion (94%) or NSTEMI revascularization (84%) status were not significantly different between patients who attended >26 or ≤26 sessions. Increasing number of rehab sessions attended was associated with lower mortality rates (Figure). This association remained significant after multivariable adjustment (adjusted HR 0.87, 95% CI 0.83-0.91 per increase in 5 sessions completed).
Conclusions: In this Medicare population, only one third of referred patients enrolled in a cardiac rehabilitation program after an acute MI. Of enrolled patients, the number of rehab sessions attended was independently associated with improved survival. These data strongly support the need for continued efforts to encourage enrollment and persistence in cardiac rehabilitation programs.
- © 2013 by American Heart Association, Inc.