Cardiac rehabilitation and all-cause mortality in patients with heart failure: a retrospective cohort study

• Published in: European journal of preventive cardiology Vol. 28; no. 15; p. 1704
• Main Authors: Buckley, Benjamin J R, Harrison, Stephanie L, Fazio-Eynullayeva, Elnara, Underhill, Paula, Sankaranarayanan, Rajiv, Wright, David J, Thijssen, Dick H J, Lip, Gregory Y H
• Format: Journal Article
• Language: English
• Published: England 29.12.2021
• Subjects: Atrial Fibrillation; Cardiac Rehabilitation - methods; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - therapy; Hospitalization; Humans; Retrospective Studies; Stroke Volume; Heart failure; Secondary prevention; Retrospective cohort; Exercise; Cardiac rehabilitation
• ISSN: 2047-4881
• DOI: 10.1093/eurjpc/zwab035

Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF). The aim of this study was therefore to investigate the association of exercise-based CR with all-cause mortality, hospitalisation, stroke, and atrial fibrillation in patients with heart failure. A retrospective cohort study was conducted which utilized a global federated health research network, primarily in the USA. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of CR and/or exercise programmes within 6 months of an HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, comorbidities, medications, and procedures (controls). We ascertained 2-year incidence of all-cause mortality, hospitalization, stroke, and atrial fibrillation. Following propensity score matching, a total of 40 364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality [odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62], 26% lower odds of hospitalization (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to controls, after propensity score matching. The beneficial association of CR and exercise on all-cause mortality was consistent across all subgroups, including patients with HFrEF (0.52, 95% CI 0.48-0.56) and HFpEF (0.65, 95% CI 0.60-0.71). Exercise-based CR was associated with lower odds of all-cause mortality, hospitalizations, incident stroke, and incident atrial fibrillation at 2-year follow-up for patients with HF (including patients with HFrEF and HFpEF).