Patients who do not complete cardiac rehabilitation have an increased risk of cardiovascular events during long-term follow-up

Abstract

Background Cardiac rehabilitation (CR) has favourable effects on cardiovascular mortality and morbidity. Therefore, it might reasonable to expect that incomplete CR participation will result in suboptimal patient outcomes. Methods We studied the 914 post-acute coronary syndrome patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE) trial. They all started a 'standard' CR programme, with physical exercises (group sessions) twice a week for 12 weeks. Incomplete CR was defined as participation in <75% of the scheduled exercise sessions. Patients were followedup for 2.7 years, and the incidence of cardiac events was recorded. Major adverse cardiac events (MACE) included all-cause mortality, non-fatal myocardial infarction and coronary revascularisation. Results A total of 142 (16%) patients had incomplete CR. They had a higher incidence of MACE than their counterparts who completed CR (11.3% versus 3.8%, adjusted hazard ratio [aHR] 2.86 and 95% confidence interval [CI] 1.47-5.26). Furthermore, the incidence of any cardiac event, including MACE and coronary revascularisation, was higher (20.4% versus 11.0%, aHR 1.54; 95% CI 0.98-2.44). Patients with incomplete CR were more often persistent smokers than M. Sunamura · N. ter Hoeve those who completed CR (31.7% versus 11.5%), but clinical characteristics were similar otherwise. Conclusion Post-ACS patients who did not complete a 'standard' 12-week CR programme had a higher incidence of adverse cardiac events during long-term follow-up than those who completed the programme. Since CR is proven beneficial, further research is needed to understand the reasons why patients terminate prematurely.

Analysis of Complications of Acute Coronary Syndrome and Their Outcomes in India

“…Inotrope was given in 36 cases (72%). Mainly 66% of cases were kept on mechanical ventilation; out of that 21 on intermittent positive-pressure ventilation (IPPV) and 12 on BIPAP (Bi-level Positi- This cohort presented to hospital in 9 hours compared to Van den Berg, et al [17,18] study which quotes duration of 3.5 hours. In our study 82% of patients presented before 12 hours of onset of symptoms which reflects increase in awareness of patients.…”

Cardiac rehabilitation and telemedicine (and COVID-19)

“…Dropout is associated with unfavourable outcomes, as reported by Sunamura et al. in this issue [ 5 ]. Premature termination of the CR programme represents a loss of benefits, a waste of resources and a waste of the limited capacity for CR.…”

Cardiac rehabilitation via telerehabilitation in COVID-19 pandemic situation

“…The rehabilitation program benefits are gained from the direct physiological effects of physical exercises and the indirect effects of risk factors control, lifestyle modification, and mood. Several studies had shown that patients who underwent CR programs following primary PCI had a lower mortality rate [ 13 , 16 ].…”

“…Patients frequently do not participate in CR due to their low perception of the program’s importance and necessity. The less optimal participation may lead to less optimal results in CR [ 3 , 16 ].…”

“…Cardiac rehabilitation is also considered to improve cardiorespiratory fitness and heart rate recovery, which are indicators of autonomic function in coronary artery disease (CAD) patients with a previous MI history. Cardiac rehabilitation may reduce the length of stay, depression rate, the incidence of recurrent acute coronary syndrome, disability, stroke, and on the other hand, improve medication adherence [15][16][17].…”