Abstract 19790: Cardiac Rehabilitation Not Clearly Associated With Reduction of MACE Events in the First 30 Days Post Hospital Discharge
Background: There is an increased risk of cardiovascular events including death in patients who experience acute myocardial infarction (AMI). Cardiac rehabilitation (CR) results in long term benefits, reducing death, recurrent cardiovascular events, and reducing coronary symptoms in these patients. It is unclear whether early outpatient CR can significantly impact outcomes within the first 30 days.
Methods: A total of 5,572 AMI patients seen at an Intermountain Healthcare hospital from January, 2012 to May, 2016 were studied. Patients were stratified by whether they did (n=3,093 [54.2%]) or did not (n=2611 [45.8%]) receive CR within 30 days of hospital discharge. A sub-analysis was performed on a propensity matched (±0.01) population. Patients were followed for the occurrence of MACE (death, MI, heart failure [HF] hospitalization, stroke).
Results: In comparison to CR patients, no CR were older (68.9% vs 64%) and had more comorbidities: hypertension (85.1% vs 78.9%), diabetes (44.5% vs 34.6%), prior stroke (8.8% vs 3.9%), heart failure (41.5% vs 37.1%), and renal insufficiency (35.1% vs 13.7%), all p-value ≤0.0001. MACE occurred in 9.1% of CR and in 17.2% of no-CR patients (p<0.0001), with the lower event rates seen in the CR patients being driven by death, stroke, and HF hospitalization (Table). The CR patients experienced more follow-up MIs. Among the propensity matched population (n=3,498 [no-CR=1,749, CR=1,749), the prevalence of risk factors were similar, resulting in similar rates of death and HF hospitalizations (Table).
Conclusion: Among AMI patients, almost half did not attend CR during the first 30 days after discharge. These patients had significantly more comorbidities and also adverse events. After propensity matching, 30 day outcomes were similar. Therefore, in the absence of a randomized trial, the effect of outpatient CR on early clinical outcomes may not be identifiable. The unexpected increase in MI events in the CR cohort requires further study.
Author Disclosures: V.T. Le: None. H.T. May: None. J. Benuzillo: None. T.L. Bair: None. D.L. Lappé: None. K.U. Knowlton: None. J.B. Muhlestein: None.
- © 2016 by American Heart Association, Inc.