Abstract 18122: Cardiac Rehabilitation in Subjects With Peripheral Arterial Disease: A Higher Risk Patient Population Who Benefit From Attendance
Introduction: Peripheral vascular disease (PAD) is a common co-morbidity in subjects with coronary artery disease referred for cardiac rehabilitation (CR).
Hypothesis: Subjects with PAD derive benefit from CR, but are less likely to attend.
Methods: This study included all subjects who were referred to a 12-week, exercise based CR program in Calgary, Canada between 1996 and 2013. Baseline patient characteristics including age, sex, and clinical characteristics were compared between those who completed CR and did not. Rates of attendance and completion were compared by PAD, as was change in exercise capacity measured by exercise testing over the course of CR for all those who completed the program. Unadjusted and adjusted (for all available clinical covariates) Cox proportional hazard models were constructed to assess the association between CR completion and mortality. Models were stratified by PAD diagnosis.
Results: A total of 15927 subjects were referred to CR; of those, only 894 (5.6%) had a formal diagnosis of PAD. Subjects with PAD were less likely to complete CR (44.4 vs 55.6% for non-PAD, p<0.0001), and more likely to drop out if they started (23.8 vs 17.2%, p<0.0001). PAD patients also achieved a lesser improvement in exercise capacity over the course of CR (0.76 vs 0.90 METs, p=0.0029). There were 1569 deaths over the course of follow-up; 5 year survival was lower in those with PAD (87.9 vs 94.9%) (Figure). CR attendance was associated with a similar reduction in mortality for those with (HR 0.62, 95%CI 0.44, 0.85) and without (HR 0.55, 95%CI 0.49, 0.61) PAD in adjusted models.
Conclusions: Subjects with coexisting PAD in a CR program have a higher mortality and thus are a higher risk CR group. They derive significant mortality reduction from attending CR even though they have less improvement in their exercise capacity. They are, however, less likely to attend and more likely to drop out. Removing barriers to CR attendance and completion is important for those suffering from PAD.
Author Disclosures: B. Martin: None. A. Devrome: None. T. Hauer: None. L. Austford: None. R. Arena: None. J.A. Stone: None. S. Aggarwal: None.
- © 2016 by American Heart Association, Inc.