Abstract
BackgroundCardiac rehabilitation (CR) has favourable effects on cardiovascular mortality and morbidity. Therefore, it might reasonable to expect that incomplete CR participation will result in suboptimal patient outcomes.MethodsWe studied the 914 post-acute coronary syndrome patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE) trial. They all started a ‘standard’ CR programme, with physical exercises (group sessions) twice a week for 12 weeks. Incomplete CR was defined as participation in <75% of the scheduled exercise sessions. Patients were followed-up for 2.7 years, and the incidence of cardiac events was recorded. Major adverse cardiac events (MACE) included all-cause mortality, non-fatal myocardial infarction and coronary revascularisation.ResultsA total of 142 (16%) patients had incomplete CR. They had a higher incidence of MACE than their counterparts who completed CR (11.3% versus 3.8%, adjusted hazard ratio [aHR] 2.86 and 95% confidence interval [CI] 1.47–5.26). Furthermore, the incidence of any cardiac event, including MACE and coronary revascularisation, was higher (20.4% versus 11.0%, aHR 1.54; 95% CI 0.98–2.44). Patients with incomplete CR were more often persistent smokers than those who completed CR (31.7% versus 11.5%), but clinical characteristics were similar otherwise.ConclusionPost-ACS patients who did not complete a ‘standard’ 12-week CR programme had a higher incidence of adverse cardiac events during long-term follow-up than those who completed the programme. Since CR is proven beneficial, further research is needed to understand the reasons why patients terminate prematurely.
Highlights
Cardiac Rehabilitation (CR) is a class I recommended intervention in patients with coronary artery disease and has beneficial effects on physical fitness, quality of life, cardiovascular risk factors and clinical outcome, including mortality [1,2,3,4,5]
914 patients who were discharged after acute coronary syndrome (ACS) admission were scheduled to receive ‘standard’ Cardiac rehabilitation (CR) for 12 weeks according to the European Society of Cardiology (ESC) guidelines [16]
The cumulative incidence of any cardiovascular event at 4 years in complete CR versus incomplete CR was 18% and 25% according to the Kaplan-Meier method, respectively (Fig. 1)
Summary
Cardiac Rehabilitation (CR) is a class I recommended intervention in patients with coronary artery disease and has beneficial effects on physical fitness, quality of life, cardiovascular risk factors and clinical outcome, including mortality [1,2,3,4,5]. What’s more, a substantial number of patients that do participate in CR attend only a few sessions and drop out prematurely. It might reasonably be expected that such suboptimal CR participation will in less favourable results as. M. Sunamura · N. ter Hoeve Capri Cardiac Rehabilitation, Rotterdam, The Netherlands. J. G. van den Berg-Emons Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Cardiac rehabilitation (CR) has favourable effects on cardiovascular mortality and morbidity. It might reasonable to expect that incomplete CR participation will result in suboptimal patient outcomes
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Schedule a callMore From: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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