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Eur Heart J. 2018 Jul 27. doi: 10.1093/eurheartj/ehy417. [Epub ahead of print]

Impact of ambulatory cardiac rehabilitation on cardiovascular outcomes: a long-term follow-up study.

Author information

1
Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Via Pietro Valdoni n. 7, Trieste, Italy.
2
Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
3
Biostatistics Unit, Department of Medical Sciences, University of Trieste, Italy.
4
Cardiovascular Rehabilitation, Ospedale Riabilitativo di Alta Specializzazione, Motta di Livenza, Italy.
5
Division of Cardiology, "Santa Maria degli Angeli" Hospital, Pordenone, ASS5, Italy.

Abstract

Aims:

To evaluate the long-term clinical impact of the application of cardiac rehabilitation (CR) early after discharge in a real-world population.

Methods and results:

We analysed the 5-year incidence of cardiovascular mortality and hospitalization for cardiovascular causes in two populations, attenders vs. non-attenders to an ambulatory CR program which were consecutively discharged from two tertiary hospitals, after ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, coronary artery bypass graft, or planned percutaneous coronary intervention. A primary analysis using multivariable regression model and a secondary analysis using the propensity score approach were performed. Between 1 January 2009 and 31 December 2010, 839 patients attended a CR program planned at discharged, while 441 patients were discharged from Cardiovascular Department without any program of CR. During follow-up, the incidence of cardiovascular mortality was 6% in both groups (P = 0.62). The composite outcome of hospitalizations for cardiovascular causes and cardiovascular mortality were lower in CR group compared to no-CR group (18% vs. 30%, P < 0.001) and was driven by lower hospitalizations for cardiovascular causes (15 vs. 27%, P < 0.001). At multivariable Cox proportional hazard analysis, CR program was independent predictor of lower occurrence of the composite outcome (hazard ratio 0.55, 95% confidence interval 0.43-0.72; P < 0.001), while in the propensity-matched analysis CR group experienced also a lower total mortality (10% vs. 19%, P = 0.002) and cardiovascular mortality (9% vs. 35%, P = 0.008) compared to no-CR group.

Conclusion:

This study showed, in a real-world population, the positive effects of ambulatory CR program in improving clinical outcomes and highlights the importance of a spread use of CR in order to reduce cardiovascular hospitalizations and cardiovascular mortality during a long-term follow-up.

PMID:
30060037
DOI:
10.1093/eurheartj/ehy417

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