TY - JOUR
T1 - Dose of cardiac rehabilitation to reduce mortality and morbidity
T2 - A population-based study
AU - Medina-Inojosa, Jose R.
AU - Grace, Sherry L.
AU - Supervia, Marta
AU - Stokin, Gorazd
AU - Bonikowske, Amanda R.
AU - Thomas, Randal
AU - Lopez-Jimenez, Francisco
N1 - Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/10/19
Y1 - 2021/10/19
N2 - BACKGROUND: There is wide variability in cardiac rehabilitation (CR) dose (ie, number of sessions) delivered, and no evidence-based recommendations regarding what dose to prescribe. We aimed to test what CR dose impacts major adverse cardiovascular events (MACEs). METHODS AND RESULTS: This is an historical cohort study of all patients who had coronary artery disease and who initiated su-pervised CR between 2002 and 2012 from a single major CR center. CR dose was defined as number of visits including exercise and patient education. Follow-up was performed using record linkage from the Rochester Epidemiology Project. MACEs included acute myocardial infarction, unstable angina, ventricular arrhythmias, stroke, revascularization, or all-cause mortality. Dose was analyzed in several ways, including tertiles, categories, and as a continuous variable. Cox models were adjusted for factors associated with dose and MACE. The cohort consisted of 2345 patients, who attended a mean of 12.5±11.1 of 36 prescribed sessions. After a mean follow-up of 6 years, 695 (29.65%) patients had a MACE, including 231 who died. CR dose was inversely associated with MACE (hazard ratio, 0.66 [95% CI]; 0.55– 0.91) in those completing ≥20 sessions, when compared with those not exposed to formal exercise sessions (≤1 session; log-rank P=0.007). We did not find evidence of nonlinearity (P≥0.050), suggesting no minimal threshold nor ceiling. Each additional session was associated with a lower rate of MACE (fully adjusted hazard ratio, 0.98 [95% CI, 0.97– 0.99]). Greater session frequency was also associated with lower MACE risk (fully adjusted hazard ratio, 0.74 [95% CI, 0.58– 0.94]). CONCLUSIONS: CR reduces MACEs, but the benefit appears to be linear, with greater risk reduction with higher doses, and no upper threshold.
AB - BACKGROUND: There is wide variability in cardiac rehabilitation (CR) dose (ie, number of sessions) delivered, and no evidence-based recommendations regarding what dose to prescribe. We aimed to test what CR dose impacts major adverse cardiovascular events (MACEs). METHODS AND RESULTS: This is an historical cohort study of all patients who had coronary artery disease and who initiated su-pervised CR between 2002 and 2012 from a single major CR center. CR dose was defined as number of visits including exercise and patient education. Follow-up was performed using record linkage from the Rochester Epidemiology Project. MACEs included acute myocardial infarction, unstable angina, ventricular arrhythmias, stroke, revascularization, or all-cause mortality. Dose was analyzed in several ways, including tertiles, categories, and as a continuous variable. Cox models were adjusted for factors associated with dose and MACE. The cohort consisted of 2345 patients, who attended a mean of 12.5±11.1 of 36 prescribed sessions. After a mean follow-up of 6 years, 695 (29.65%) patients had a MACE, including 231 who died. CR dose was inversely associated with MACE (hazard ratio, 0.66 [95% CI]; 0.55– 0.91) in those completing ≥20 sessions, when compared with those not exposed to formal exercise sessions (≤1 session; log-rank P=0.007). We did not find evidence of nonlinearity (P≥0.050), suggesting no minimal threshold nor ceiling. Each additional session was associated with a lower rate of MACE (fully adjusted hazard ratio, 0.98 [95% CI, 0.97– 0.99]). Greater session frequency was also associated with lower MACE risk (fully adjusted hazard ratio, 0.74 [95% CI, 0.58– 0.94]). CONCLUSIONS: CR reduces MACEs, but the benefit appears to be linear, with greater risk reduction with higher doses, and no upper threshold.
KW - Cardiac rehabilitation
KW - Major adverse cardiovascular events
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85119303726&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85119303726&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.021356
DO - 10.1161/JAHA.120.021356
M3 - Article
C2 - 34612055
AN - SCOPUS:85119303726
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 20
M1 - e021356
ER -