Referral for cardiac rehabilitation after acute myocardial infarction: Insights from nationwide AMIS Plus registry 2005-2017.

Abstract

BACKGROUND:

Referral rates for cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) are low despite a Class I recommendation in the present guidelines. Therefore, we aimed to identify predictors for referral and patient characteristics from the national Swiss AMIS Plus registry.

DESIGN AND METHODS:

Data were extracted from the Swiss AMIS Plus registry between 2005 and 2017, which included patients with ST-elevation myocardial infarction (STEMI) and Non-ST-elevation myocardial infarction (NSTEMI). For 32,416 patient (93.2%) data about destination at discharge were available with 10,940 (33.7%) having a recommendation for CR while 12,282 (37.9%) went home. 9194 (28.4%) were transferred to another hospital after index hospitalisation and were excluded.

RESULTS:

Patients referred to CR were younger (62.6 vs. 68.2 years) and had a higher prevalence of obesity (22.0% vs. 20.4%). Except for smoking (44.0% vs 34.9%), they had less risk factors such as dyslipidemia (55.0% vs. 60.1%), hypertension (55.6% vs. 65.3%) and diabetes (16.7% vs. 21.5%). Patients with in-hospital complications were more likely being referred for CR. Furthermore, STEMI (OR 1.61; CI 1.52-1.71), performed PCI (OR 2.65; CI 2.42-2.90) and Killip class >2 (OR 1.58; CI 1.36-1.84) favoured referral for CR, while age > 65 years, previous myocardial infarction, cerebrovascular disease or peripheral artery disease had a negative impact on referral for CR.

CONCLUSIONS:

Our data from 23,222 patients after AMI demonstrate that in Switzerland patients referred for CR are younger, more obese with more STEMI. In-hospital complications were strong predictors for CR recommendation. Unlike anticipated, other risk factors were less present in CR patients.

• Authors: Matthias Hermann, Fabienne Witassek, Paul Erne, Dragana Radovanovic, Hans Rickli
• Journal: International journal of cardiology (Int J Cardiol) Vol. 261 Pg. 1-5 (06 15 2018) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 29657032 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier B.V. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Cardiac Rehabilitation (trends)
• Cohort Studies
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, epidemiology, rehabilitation)
• Referral and Consultation (trends)
• Registries
• Switzerland (epidemiology)