Each cardiac rehab session attended cuts readmission, death risk by 2%
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Key takeaways:
- Adults with CAD who attended five or more cardiac rehab sessions had a 42.7% reduced risk for hospital readmission or death.
- The effect size was larger than in previous studies.
Patients with CAD who enrolled in cardiac rehab saw a 42.7% reduction in all-cause hospital readmission or death vs. those who did not attend sessions, a much larger effect size than seen in previous cardiac rehab studies, data show.
Many studies have evaluated demographic and clinical factors affecting clinical outcomes, readmission, recurrent MI or death within 180 days of hospital discharge; however, most models incorporating cardiac rehab participation are lacking, Brian D. Duscha, MS, an exercise physiologist and clinical trials coordinator at Duke University Medical Center, told Healio.
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“Many studies that do try to look at the efficacy of cardiac rehab do not account for all the potential variables that could affect the outcome,” Duscha said in an interview. “Some do not account for risk factors or comorbidities, such as smoking, diabetes [or] obesity, which can affect clinical outcomes. They may not control for medication usage or a patient’s discharge disposition. We tried to control for everything we possibly could. We joke that we tried to show that cardiac rehab failed, and we could not do it.”
Duscha and colleagues analyzed data from 2,641 patients with CAD who were eligible for cardiac rehab, assessing individual electronic medical records for demographic information, clinical characteristics, readmission rates and mortality information. Within the cohort, 214 patients (8%) attended at least one cardiac rehab session. Of those who attended cardiac rehab, 93% attended five or more sessions. Patients attended their first sessions on average within 41 days of hospital discharge and attended a mean 24.8 sessions during a mean period of 80 days.
Researchers defined survival as free from all-cause readmission or a composite outcome of all-cause readmission or death. The researchers estimated HRs for survival at 180 days with cardiac rehab compared with no rehab, adjusted for demographics, comorbidities and discharge criteria.
The findings were published in the Journal of Cardiopulmonary Rehabilitation and Prevention.
During 180 days of follow-up, 12.1% of patients who attended at least one cardiac rehab session and 18.7% of patients who did not attend cardiac rehab were readmitted to the hospital.
During follow-up, there was one death (0.5%) in the cardiac rehab group and 98 deaths (4%) in the no cardiac rehab group.
After adjustment for age, sex, race, depression, anxiety, dyslipidemia, hypertension, obesity, smoking, type 2 diabetes and discharge criteria, the final model revealed a significant 42.7% reduction in readmission or mortality risk for patients who attended cardiac rehab, with an HR of 0.57 (95% CI, 0.33-0.98; P = .043). Further adjustments for aspirin, statins and beta-blockers did not change the findings.
“Interestingly, most studies reporting reduced readmission or mortality risk state the value to be approximately 20% to 25%,” the researchers wrote. “Based on our results, the effect size is greater, in the range of 42% to 47%, for the composite outcome of readmission or mortality; however, we did not observe a statistically significant reduction in risk for readmission alone. Nevertheless, our analysis when compared with others lends support to the conclusion that studies likely would show greater efficacy for cardiac rehab if confounding factors were properly controlled.”
The researchers also found that the number of cardiac rehab sessions attended was related to the composite outcome, where each session attended resulted in a 2% risk reduction in all-cause readmission or mortality (HR = 0.98 per session; 95% CI, 0.96-1; P = .03).
“The more [sessions] you attend, the better,” Duscha told Healio. “For the clinician that does not refer to cardiac rehab because they may not believe it works, this study should reinforce that not only does it work, but it works better than we thought. Based on these data, why wouldn’t you refer to cardiac rehab?”
Duscha noted that the researchers were unable to adjust models for medical adherence and socioeconomic status, which likely also play a role in cardiac rehab outcomes.
For more information:
Brian D. Duscha, MS, can be reached at brian.duscha@duke.edu.
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