Participation in cardiac rehabilitation and survival after coronary artery bypass graft surgery

A community-based study

Quinn R. Pack, Kashish Goel, Brian D. Lahr, Kevin L. Greason, Ray W. Squires, Francisco Lopez-Jimenez, Zixin Zhang, Randal J. Thomas

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Background-Cardiac rehabilitation (CR) is recommended for all patients after coronary artery bypass surgery, yet little is known about the long-term mortality effects of CR in this population. Methods and Results-We performed a community-based analysis on residents of Olmsted County, Minnesota, who underwent coronary artery bypass surgery between 1996 and 2007. We assessed the association between subsequent outpatient CR attendance and long-term survival. Propensity analysis was performed. Cox proportional hazards regression was then used to assess the association between CR attendance and all-cause mortality adjusted for the propensity to attend CR. We identified 846 eligible patients (age 66±11 years, 76% men, and 96% non-Hispanic whites) who survived at least 6 months after surgery, of whom 582 (69%) attended CR. During a mean (±SD) follow-up of 9.0±3.7 years, the 10-year all-cause Kaplan-Meier mortality rate was 28% (193 deaths). Adjusted for the propensity to attend CR, participation in CR was associated with a 10-year relative risk reduction in all-cause mortality of 46% (hazard ratio, 0.54; 95% confidence interval, 0.40-0.74; P<0.001) and a 10-year absolute risk reduction of 12.7% (number needed to treat=8). There was no evidence of a differential effect of CR on mortality with respect to age (≥65 versus <65 years), sex, diabetes, or prior myocardial infarction. Conclusions-CR attendance is associated with a significant reduction in 10-year all-cause mortality after coronary artery bypass surgery. Our results strongly support national standards that recommend CR for this patient group.

Original languageEnglish (US)
Pages (from-to)590-597
Number of pages8
JournalCirculation
Volume128
Issue number6
DOIs
StatePublished - Aug 6 2013

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Coronary Artery Bypass
Transplants
Survival
Mortality
Numbers Needed To Treat
Cardiac Rehabilitation
Risk Reduction Behavior
Outpatients
Myocardial Infarction
Confidence Intervals

Keywords

  • coronary artery bypass grafting
  • mortality
  • patient compliance
  • propensity score
  • rehabilitation

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Participation in cardiac rehabilitation and survival after coronary artery bypass graft surgery : A community-based study. / Pack, Quinn R.; Goel, Kashish; Lahr, Brian D.; Greason, Kevin L.; Squires, Ray W.; Lopez-Jimenez, Francisco; Zhang, Zixin; Thomas, Randal J.

In: Circulation, Vol. 128, No. 6, 06.08.2013, p. 590-597.

Research output: Contribution to journalArticle

Pack, Quinn R. ; Goel, Kashish ; Lahr, Brian D. ; Greason, Kevin L. ; Squires, Ray W. ; Lopez-Jimenez, Francisco ; Zhang, Zixin ; Thomas, Randal J. / Participation in cardiac rehabilitation and survival after coronary artery bypass graft surgery : A community-based study. In: Circulation. 2013 ; Vol. 128, No. 6. pp. 590-597.
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abstract = "Background-Cardiac rehabilitation (CR) is recommended for all patients after coronary artery bypass surgery, yet little is known about the long-term mortality effects of CR in this population. Methods and Results-We performed a community-based analysis on residents of Olmsted County, Minnesota, who underwent coronary artery bypass surgery between 1996 and 2007. We assessed the association between subsequent outpatient CR attendance and long-term survival. Propensity analysis was performed. Cox proportional hazards regression was then used to assess the association between CR attendance and all-cause mortality adjusted for the propensity to attend CR. We identified 846 eligible patients (age 66±11 years, 76{\%} men, and 96{\%} non-Hispanic whites) who survived at least 6 months after surgery, of whom 582 (69{\%}) attended CR. During a mean (±SD) follow-up of 9.0±3.7 years, the 10-year all-cause Kaplan-Meier mortality rate was 28{\%} (193 deaths). Adjusted for the propensity to attend CR, participation in CR was associated with a 10-year relative risk reduction in all-cause mortality of 46{\%} (hazard ratio, 0.54; 95{\%} confidence interval, 0.40-0.74; P<0.001) and a 10-year absolute risk reduction of 12.7{\%} (number needed to treat=8). There was no evidence of a differential effect of CR on mortality with respect to age (≥65 versus <65 years), sex, diabetes, or prior myocardial infarction. Conclusions-CR attendance is associated with a significant reduction in 10-year all-cause mortality after coronary artery bypass surgery. Our results strongly support national standards that recommend CR for this patient group.",
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AU - Lopez-Jimenez, Francisco

AU - Zhang, Zixin

AU - Thomas, Randal J.

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