Abstract
BackgroundExercise-based cardiac rehabilitation is safe and implemented in international cardiac rehabilitation guidelines. Evidence for long-term health effects is scarce and rare for health care service research.ObjectiveThe aim of this study is to evaluate the effectiveness of exercise-based phase III cardiac rehabilitation programs in improving mortality and working capacity outcomes.MethodsThe present analyses used claims data of the German pension fund from 2010 to 2017. Overall, 54,163 patients with coronary heart disease (ICD10 I20.–I25.) were included and followed up for exercise-based cardiac rehabilitation participation (mean 4.3 ± 1.9 years). All patients were categorized according to participation duration (long: ≥ 90 days, short: < 90 days, no). The effectiveness of exercise-based rehabilitation was analyzed by calculating adjusted hazard ratios for mortality and reduced working capacity in relation to program participation.ResultsOf all the cardiac patients, 57.6% received medical recommendations for exercise-based phase III rehabilitation, and 16.8% participated in this rehabilitation. In total, 1776 (3.3%) patients died during the study period, and 3050 (5.5%) received reduced earning capacity pensions. Mortality risk was nearly doubled for those who did not participate in exercise-based cardiac rehabilitation compared to those who participated for a long duration (HR 1.97, 95% CI 1.60–2.43) and 44% higher compared to a short participation (HR 1.44, 95% CI 1.03–2.01). Furthermore, the risk of reduced working capacity was higher for those who did not participate compared to those who participated for a short duration (HR 1.24, 95% CI 1.00–1.54).ConclusionExercise-based phase III cardiac rehabilitation is independently associated with reduced mortality and reduced loss in working capacity. Strong efforts should be made to increase participation rates to improve cardiac patients care.
Highlights
Coronary heart disease (CHD) or ischemic heart disease is the second leading cause of disability-adjusted life years (DALYs) worldwide
Mortality risk was nearly doubled for those who did not participate in exercise-based cardiac rehabilitation compared to those who participated for a long duration (HR 1.97, 95% Confidence interval (CI) 1.60–2.43) and 44% higher compared to a short participation (HR 1.44, 95% CI 1.03–2.01)
The risk of reduced working capacity was higher for those who did not participate compared to those who participated for a short duration (HR 1.24, 95% CI 1.00–1.54)
Summary
Coronary heart disease (CHD) or ischemic heart disease is the second leading cause of disability-adjusted life years (DALYs) worldwide. It is the leading cause of DALYs among persons over 50 years of age [1]. The German healthcare system offers inpatient or outpatient rehabilitation care for CHD patients, and the associated costs are covered by social insurance agencies. Depending on the patient’s age and working ability, rehabilitation measures must be paid for by statutory health insurances, the German pension fund (DRV), or private health insurances (e.g., for patients who have higherincome levels, are self-employed, or are civil servants). For the majority of the working population, the German pension fund covers rehabilitation costs. Evidence for long-term health effects is scarce and rare for health care service research
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
