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J Am Heart Assoc. 2018 Oct 2;7(19):e010010. doi: 10.1161/JAHA.118.010010.

Cardiac Rehabilitation Participation and Mortality After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

Author information

1
1 Center of Innovation for Veteran-Centered and Value-Driven Care Veterans Affairs Puget Sound Health Care System Seattle WA.
2
2 Department of Medicine University of Washington Seattle WA.
3
4 Department of Medicine San Francisco VA Medical Center San Francisco CA.
4
5 Department of Medicine University of California San Francisco CA.
5
3 School of Public Health University of Washington Seattle WA.
6
7 Veterans Affairs Clinical Assessment, Reporting, and Tracking VA Eastern Colorado Health Care System Denver CO.
7
6 Department of Epidemiology and Biostatistics University of California San Francisco CA.

Abstract

Background Cardiac rehabilitation (CR) is strongly recommended after percutaneous coronary intervention (PCI), but it is underused. We sought to evaluate CR participation variation after PCI and its association with mortality among veterans. Methods and Results Patients undergoing PCI between 2007 and 2011 were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking database and followed up until January 25, 2017. We excluded patients who died within 30 days of PCI and calculated the percentage participating in ≥1 outpatient CR visits within 12 months after PCI. We constructed multivariable hierarchical logistic regression models for CR participation, clustered by facility. We estimated propensity scores for CR participation, matched participants and nonparticipants by propensity score, calculated mortality rates, and estimated the association with mortality using Cox proportional hazards models. Participation in CR after PCI was 6.9% (2986/43 319) and varied significantly by PCI facility (range, 0%-36%). After 6.1 years median follow-up, CR participants had a 33% lower mortality rate than all nonparticipants (3.8 versus 5.7 deaths/100 person-years; hazard ratio, 0.67; 95% confidence interval, 0.61-0.75; P<0.001) and a 26% lower mortality rate than 2986 propensity-matched nonparticipants (3.8 versus 5.1 deaths/100 person-years; hazard ratio, 0.74; 95% confidence interval, 0.65-0.84; P<0.001). Participants attending ≥36 sessions had the lowest mortality rate (2.4 deaths/100 person-years; hazard ratio, 0.47; 95% confidence interval, 0.36-0.60; P<0.001). Conclusions CR participation after PCI among veterans is low overall, with significant facility-level variation. CR participation is associated with lower mortality rates in veterans. Additional efforts are needed to promote CR participation after PCI among veterans.

KEYWORDS:

cardiac rehabilitation; health services; percutaneous coronary intervention; quality and outcomes; secondary prevention

PMID:
30371315
PMCID:
PMC6404876
DOI:
10.1161/JAHA.118.010010
[Indexed for MEDLINE]
Free PMC Article

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