Association between cardiac rehabilitation participation and health status outcomes after acute myocardial infarction
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Abstract
Cardiac rehabilitation (CR) is a class Ia recommendation and endorsed performance measure for the quality of care in acute myocardial infarction (AMI) survivors. While participation in CR after AMI is associated with reduced mortality, conflicting data exists on its association with health status outcomes. Using data from 2 prospective AMI registries (TRIUMPH and PREMIER), we identified patients for whom baseline and follow-up health status scores and documentation of CR participation (attendance of 1 or more sessions within 6 months post-AMI) were available. Health status was assessed by four Seattle Angina Questionnaire (SAQ) domain scores (quality of life [QoL], angina frequency [AF], treatment satisfaction [TS], and physical limitation [PL]), as well as SF-12 physical and mental health composite scores (PCS & MCS). We propensity-matched CR participants and non-participants to examine the association between CR participation with health status (6 and 12 months) and all-cause mortality (up to 7 years), using linear, mixed effects and proportional hazards models, respectively. Among 3,957 AMI patients from 31 sites, 2,015 patients (51%) participated in CR after discharge. Several differences were noted in baseline characteristics of CR participants and non-participants. CR participants were more frequently Caucasian (83.6% vs. 65.4%), had higher rates of health insurance (90.6% vs. 79.3%), and had lower rates of co-morbidities. Baseline health status domain scores were clinically similar for both groups with the exception of SAQ physical limitation scores being higher in CR participants. After propensity matching, all covariates were well-balanced (Standardized Difference <10) and the mean SAQ and SF-12 scores were clinically similar for CR participants and non-participants at 6 and 12 months after hospital discharge. However, a decrease in all-cause mortality was noted in the CR participant group (HR 0.59, 95% CI [0.46, 0.75]). In 2 large, multi-center AMI cohorts, we found that although CR participation was associated with improved survival, no additional health status benefits were conferred. Further investigation is required to identify if and how CR programs can further maximize the health status benefits to post-AMI participants.
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Introduction -- Methods -- Results -- Discussion -- Conclusion
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M.S.