Cardiac Rehabilitation and Outcome in Stable Outpatients With Recent Myocardial Infarction

• Published in: Archives of physical medicine and rehabilitation Vol. 95; no. 2; pp. 322 - 329
• Main Authors: Coll-Fernández, Roser, MD, Coll, Ramon, MD, PhD, Pascual, Teresa, MD, Sánchez Muñoz-Torrero, J. Francisco, MD, PhD, Sahuquillo, Joan Carles, MD, PhD, Manzano, Luis, MD, PhD, Aguilar, Eduardo, MD, Alcala-Pedrajas, José N., MD, Álvarez, Lorenzo Ramón, MD, PhD, García-Díaz, Ana María, MD, Mujal, Abel, MD, Yeste, Montserrat, MD, Monreal, Manuel, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2014
• Subjects: Aged; Amputation - statistics & numerical data; Comorbidity; Female; Humans; Longitudinal Studies; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - rehabilitation; Physical Medicine and Rehabilitation; Recurrence; Risk Factors; Stroke - epidemiology; Treatment Outcome; confidence interval; FRENA; Risk Factors and Arterial Disease; MI; CI; myocardial infarction
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2013.09.020

Abstract Objective To compare the mortality rate and the rate of subsequent ischemic events (myocardial infarction [MI], ischemic stroke, or limb amputation) in patients with recent MI according to the use of cardiac rehabilitation or no rehabilitation. Design Longitudinal observational study. Setting Ongoing registry of outpatients. Participants Patients (N=1043) with recent acute MI were recruited; of these, 521 (50%) participated in cardiac rehabilitation. Interventions Not applicable. Main Outcome Measures Subsequent ischemic events and mortality rates were registered. Results Over a mean follow-up of 18 months, 50 patients (4.8%) died and 49 (4.7%) developed 52 subsequent ischemic events (MI: n=43, ischemic stroke: n=6, limb amputation: n=3). Both the mortality rate (.16 vs 5.57 deaths per 100 patient-years; rate ratio=.03; 95% confidence interval [CI], 0.0–0.1]) and the rate of subsequent ischemic events (1.65 vs 4.54 events per 100 patient-years; rate ratio=0.4; 95% CI, 0.2–0.7) were significantly lower in cardiac rehabilitation participants than in nonparticipants. Multivariate analysis confirmed that patients in cardiac rehabilitation had a significantly lower risk of death (hazard ratio=.08; 95% CI, .01–.63; P =.016) and a nonsignificant lower risk of subsequent ischemic events (hazard ratio=.65; 95% CI, .30–1.42). Conclusions The use of cardiac rehabilitation in patients with recent MI was independently associated with a significant decrease in the mortality rate and a nonsignificant decrease in the rate of subsequent ischemic events.