Cardiac Rehabilitation Attendance and Outcomes in Coronary Artery Disease Patients
Background—Cardiac rehabilitation (CR) is an efficacious yet underutilized treatment for patients with coronary artery disease (CAD). The objective of this study was to determine the association between CR completion and mortality and resource utilization.
Methods and Results—We conducted a prospective cohort study of 5886 subjects (20.8% female, mean age 60.6years) who had undergone angiography and were referred for CR in Calgary, Canada between 1996 and 2009. Outcomes of interest included freedom from emergency room (ER) visits, hospitalization and survival in CR completers vs. non-completers, adjusted for clinical covariates, treatment strategy and coronary anatomy. Hazard ratios (HR) for events for CR completers vs. non-completers were also constructed. A propensity model was used to match completers to non-completers on baseline characteristics, and each outcome was compared between propensity-matched groups. Of the subjects referred for CR, 2900 (49.3%) completed the program, and an additional 554 subjects started but did not complete CR. CR completion was associated with a lower risk of death, with an adjusted HR of 0.59 (95%CI 0.49, 0.70). CR completion was also associated with a decreased risk of all cause hospitalization (adjusted HR 0.77 (95%CI 0.71, 0.84) and cardiac hospitalization (adjusted HR 0.68, 95%CI 0.55, 0.83), but no association with ER visits. Propensity matched analysis demonstrated a persistent association between CR completion and reduced mortality.
Conclusions—Among those CAD patients referred, CR completion is associated with improved survival and decreased hospitalization. There is a need to explore reasons for non-attendance and to test interventions to improve attendance post-referral.
- coronary artery disease
- propensity score
- secondary prevention
- Received September 7, 2011.
- Accepted May 31, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited