Abstract 19823: Japanese Multicenter Study on the Prognostic Efficacy of Out-patient Cardiac Rehabilitation in Patients With Coronary Artery Disease: J-REHAB

Abstract

Introduction: Although the prognostic efficacy of out-patient cardiac rehabilitation (OPCR) in patients with coronary artery disease (CAD) has been established in Western countries, it has not been studied in Japan, where both incidence and mortality of CAD are known to be much lower than in Western counties. Methods: To determine the prognostic efficacy of OPCR in Japan, a prospective, controlled, multicenter study of OPCR (J-REHAB) was conducted in 15 hospitals in Japan. A total of 1047 patients hospitalized with cardiac events were prospectively assigned to either OPCR group (n=848) or Non-OPCR group (n=199) according to patient’s preference at the time of hospital discharge. Patients in OPCR group were scheduled to participate in a comprehensive OPCR program for 3 months and Non-OPCR group received usual care. Event-free survivals for cardiac and all-cause death/rehospitalization were assessed according to the initial group assignment and the “prespecified” actual OPCR performance (attendance >=4 times/month and total exercise time >=150 min/week). Results: Patients were followed-up for 416days on average and the follow-up rate was 99.4%. At baseline, patients were 64±11years of age, 85% was male, 58% acute myocardial infarction, with preserved EF (53±13%). By Kaplan-Meier analysis, OPCR group had significantly better event-free survival for cardiac death/rehospitalization (p<0.05) and all-cause death/rehospitalization (p<0.001) than Non-OPCR group. However, after Cox proportional hazard analysis including patient characteristics (underlying heart disease, NYHA class, EF, residual coronary stenosis, heart rate, peak oxygen uptake, and ACE inhibitor/ARB), these differences were no more significant. In contrast, Cox analysis based on prespecified actual OPCR performance (good [n=352], partial [n=321], and poor [n=374]) revealed that good OPCR performance (i.e., active participation) was a potent independent determinant of both cardiac and all-cause event-free survival (both p<0.01). Conclusions: The first Japanese prospective multicenter J-REHAB study has demonstrated that active participation in OPCR is associated with better event-free survival in CAD patients, independent of baseline clinical characteristics.