Abstract 13925: Impact of In-hospital Acute Phase Cardiac Rehabilitation on Long-term Cardiovascular Outcomes in Acute Myocardial Infarction Patients
Background: Cardiac rehabilitation (CR) post ST elevation acute myocardial infarction (STEMI) remains an underused tool. In part, this arises from uncertainty regarding the efficacy of CR, particularly acute phase CR. We therefore investigated the impact of in-hospital CR post STEMI on long-term cardiovascular outcomes.
Methods: We enrolled 472 patients with successful reperfusion therapy within 12 hours of onset of STEMI, between October 2001 and October 2008. All patients were included to participate in the acute phase CR program during hospitalization and were followed for cardiovascular events which consist of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Total number of walking CR times during hospitalization was counted and included into analyses.
Results: During the 2592 person-years of follow-up, 83 patients (17.6%) experienced cardiovascular events. In-hospital CR was performed fewer in patients with cardiovascular events compared with those without events [median number of CR times (interquartile range); 6 (3 to 8) versus 7 (4 to 10.5), p=0.001.] Even after adjustment for age, sex, coronary risk factors, length of hospital stay, days in bed, left ventricular ejection fraction, left anterior descending coronary artery culprit, frailty as assessed by gait speed, and comorbidity index, increase in in-hospital CR times by 1 was associated with 8% reduction in subsequent cardiovascular events (hazard ratio for increasing 1 time of in-hospital CR: 0.92, 95% confidence interval: 0.861 - 0.983, p=0.014). Kaplan-Meier analysis, according to the tertile of number of in-hospital CR times, showed that patients with fewer in-hospital CR experienced higher rate of subsequent cardiovascular events (Figure).
Conclusion: In-hospital CR post STEMI was associated with significant reductions in subsequent cardiovascular events, suggesting that even short CR programs may translate into improved long-term outcomes.
Author Disclosures: C. Kawashima: None. Y. Mtsuzawa: None. H. Suzuki: None. E. Akiyama: None. N. Maejima: None. N. Iwahashi: None. K. Tsukahara: None. K. Hibi: None. M. Kosuge: None. T. Ebina: None. S. Umemura: Research Grant; Modest; Torii. Research Grant; Significant; Pfizer, Dainippon-Sumitomo, Astellas, Shionogi, Daiichi-Sankyo, MSD, Astrazeneca, Novartis, Nihon-Boehringer-Ingelheim. Honoraria; Modest; Shionogi, MSD, Kyowa-Hakko-Kirin. K. Kimura: Research Grant; Significant; Toa Eiyo Ltd, Bayer, MSD, Astellas, Astrazeneca, Sanofi, Eli Lilly Japan, Research Institute for Production Development, Novartis, Bayer, Pfizer, Shionogi, Kowa-souyaku, Daiichi-Sankyo, Mitsubishi Tanabe, Nihon-Boehringer -Ingelheim, Takeda, Otsuka, Ono. Honoraria; Modest; Astrazeneca. Honoraria; Significant; MSD.
- © 2014 by American Heart Association, Inc.