Impact of cardiac rehabilitation referral on one-year outcome after discharge of patients with acute myocardial infarction.

Abstract

BACKGROUND:

Cardiac rehabilitation after an acute myocardial infarction has a class I recommendation in the present guidelines. However, data about the impact on mortality in Switzerland are not available. Therefore, we analysed one-year outcome of acute myocardial infarction patients according to cardiac rehabilitation referral at discharge.

DESIGN AND METHODS:

Data were extracted from the Swiss AMIS Plus registry and included patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, who were asked to give their informed consent to a telephone follow-up one year after discharge.

RESULTS:

From 10,141 patients, 1956 refused to participate in follow-up and 302 were lost to follow-up. There were 4508 (57.2%) patients with cardiac rehabilitation referrals compared with 3375 (42.8%) without. Patients referred to cardiac rehabilitation were younger (62.4 years vs. 68.8 years), more often male (77% vs. 70%), presented more often with ST-elevation myocardial infarction (63.5% vs. 52.1%) and, apart from smoking (44.0% vs. 34.9%), they had fewer risk factors, such as dyslipidaemia (55.0% vs. 60.1%), hypertension (55.6% vs. 65.3%) and diabetes (16.7% vs. 21.5%). Patients referred to cardiac rehabilitation had a lower crude one-year all-cause mortality (1.7% vs. 5.8%; p < 0.001) and lower rates of re-infarction, rehospitalization for cardiovascular disease and intervention (all p < 0.005). In a multivariable logistic regression analysis, cardiac rehabilitation was an independent predictor for lower mortality rate (odds ratio 0.65; 95% confidence interval 0.48-0.89; p = 0.007).

CONCLUSIONS:

Although the detailed data of cardiac rehabilitation programmes and patient participation were not available for this study, our data from 7883 acute myocardial infarction patients showed a better one-year outcome for patients with cardiac rehabilitation referrals than for those without.

• Authors: Matthias Hermann, Fabienne Witassek, Paul Erne, Hans Rickli, Dragana Radovanovic
• Journal: European journal of preventive cardiology (Eur J Prev Cardiol) Vol. 26 Issue 2 Pg. 138-144 (01 2019) ISSN: 2047-4881 [Electronic] England
• PMID: 30335503 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Cardiac Rehabilitation
• Cause of Death
• Female
• Humans
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction (diagnosis, mortality, physiopathology, rehabilitation)
• Patient Discharge
• Patient Readmission
• Recurrence
• Referral and Consultation
• Registries
• Risk Assessment
• Risk Factors
• ST Elevation Myocardial Infarction (diagnosis, mortality, physiopathology, rehabilitation)
• Switzerland (epidemiology)
• Time Factors
• Treatment Outcome