Cardiac rehab after CABG tied to reduced risk for mortality at 2 years
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Key takeaways:
- In patients who had coronary artery bypass grafting, those who attended cardiac rehabilitation were more likely to survive at 2 years than those who did not.
- Only 60% of patients attended cardiac rehab.
Among patients who underwent CABG, those who attended cardiac rehabilitation were more likely to survive at 2 years compared with those who were not, researchers reported.
“Data describing the benefits of cardiac rehab for cardiac surgical patients has been limited and are outdated, so we sought to provide more contemporary evidence for this population with more granular clinical data,” Michael P. Thompson, PhD, assistant professor of cardiac surgery at the University of Michigan Medical School, told Healio.
Thompson and colleagues analyzed 6,412 Medicare beneficiaries residing in Michigan (mean age, 71 years; 29% women; 91% white) who were discharged alive after CABG from January 2015 to September 2019. They assessed outpatient facility claims to determine which patients used cardiac rehab within 1 year of discharge.
The primary outcome was mortality at 2 years, assessed in an unadjusted analysis and by inverse probability treatment weighting.
Less than two-thirds in cardiac rehab
Among the cohort, 60% were enrolled in cardiac rehab. Among those enrolled, the average duration was 12 sessions, and 12% of patients completed the recommended 36 sessions.
Independent predictors of cardiac rehab use included increasing age, discharge to home as opposed to an extended care facility and shorter length of hospital stay (P < .05 for all), according to the researchers.
In the unadjusted analysis, 2-year mortality was lower for those who were enrolled in cardiac rehab than in those who were not (3.7% vs. 13.1%; reduction, –9.4 percentage points; 95% CI, –10.8 to –7.9; P < .001), Thompson and colleagues found.
Those who attended all 36 sessions had a lower mortality rate than those who attended one to 11 sessions (2.7% vs. 5.2%), the researchers wrote.
In the inverse probability treatment weighting analysis, the reduction in mortality was –4.8% (95% CI, –6 to –3.5; P < .001) in favor of the cardiac rehab group, and a multivariable analysis produced similar results (reduction, –5.5%; 95% CI, –6.9 to –4.2; P < .001).
“Cardiac rehab improves outcomes through a number of pathways, such as improving cardiovascular function through exercise training, encouraging and reinforcing health behaviors, and providing emotional and social support, which all likely contribute to improved outcomes,” Thompson told Healio. “Some of the observed benefits, however, may be attributed to selection of healthier patients, although we sought to mitigate this issue in our study.”
Barriers to participation
There are barriers to participation in cardiac rehab that need to be addressed, he said.
“A critical barrier to cardiac rehab participation is the lack of understanding of the role and benefits of cardiac rehab by patients and providers, which could be addressed through patient and provider education or the addition of trained support staff,” Thompson told Healio. “Cardiac rehab liaison programs have been shown to improve participation through increased education and awareness of cardiac rehab by both patients and providers. In Michigan, we have developed a network of stakeholders to facilitate quality improvement efforts around cardiac rehab participation, called the Michigan Cardiac Rehab Network. This network applies the collaborative quality improvement model, which has had broad success in Michigan, to address underuse of cardiac rehab through performance benchmarking, peer-to-peer learning and voluntary pay-for-performance incentives. We believe these efforts can be successful where previous efforts to improve cardiac rehab participation have fallen short.”
For more information:
Michael P. Thompson, PhD, can be reached at mthomps@med.umich.edu.
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