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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

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



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.


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.


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