P6060Cardiac rehabilitation referral in lombardy region: a population study on incident cases from 2005 to 2012

Cardiac Prevention and Rehabilitation “3.0”: From acute to chronic phase. Position Paper of the ltalian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR)

“…1. The most important light is the effectiveness of CPR, demonstrated not only by the innumerable meta-analyses that have included mostly North American or Northern European cases and have been often cited in this position paper, but now also by large Italian national cases [11,29], with results that are based on both clinical and administrative data and can be deduced from both the outpatient and inpatient content. 2.…”

“…The data presented at the last ESC Congress represent a first important step in this direction [29]. In fact, the report analyzes two groups of patients from the Lombardy Region database, discharged with a diagnosis of heart failure between 2005 and 2012.…”

“…To give some examples, the need to evaluate and manage the problem of frailty, the need to reprocess contents and programs related to the exercise component in virtue of the new therapeutic options now offered to a broader range of individuals (from those after transcatheter aortic valve replacement to those receiving a ventricular assist device as destination therapy), the need to extend the concept of Position Paper different covariates, the risk of all-cause death and readmission in patients undergoing CPR, was, respectively, 0.5768 (IC 0.5650-0.5888, p<0.0001) and 0.7997 (IC 0.7758-0.8244, p<0.0001) [29].…”

“…Among the many factors that determine patients after an acute event at risk of short-term readmission, a major one certainly is the persistence of hemodynamic congestion, despite the improvement of symptoms. Recent data from the administrative database of the Lombardy Region presented at the ESC Congress regarding more than 140,000 subjects with heart failure incident in the years 2005-2012, of whom 29% underwent CPR, showed that the transition to one of the rehabilitation cardiology facilities reduced mortality and readmission and favored the implementation of the recommended therapies [29]. It is important to note that admission to CPR only rarely followed the "incident" episode; it tended to be recommended only after several episodes of instability and readmissions to acute care (on average after 3.26 ± 1.78 hospitalizations).…”

Cardiac rehabilitation in heart failure after the ExTraMATCH II study: who still believes?

“…We already have some embryonic evidence about the positive effect of ExCR in this vulnerable phase. The Lombardy Region of Italy is characterized by a large (more than 50 facilities) cardiac rehabilitation network, strongly connected to acute cardiac wards: in this favourable scenario, according to administrative data collected on more than 140 000 heart failure cases from 2005 to 2012 (therefore in the modern era), patients actively referred to cardiac rehabilitation after hospitalization in acute care had lower mortality and readmission rates, which decreased by 43% and 31%, respectively, as compared to patients who were not referred . What are these impressive numbers from the real world telling us, obviously keeping in mind several confounding aspects?…”