Abstract 27: Association Between Cardiac Rehabilitation Participation and Health Status Outcomes After Acute Myocardial Infarction
Background: Cardiac rehabilitation (CR) is a class Ia recommendation and endorsed performance measure for the quality of care in acute myocardial infarction (AMI) survivors. While participation in CR after AMI is associated with reduced mortality, conflicting data exists on its association with health status outcomes.
Methods: Using data from 2 prospective AMI registries (TRIUMPH and PREMIER), we identified patients for whom baseline and follow-up health status scores and documentation of CR participation (attendance of 1 or more sessions within 6 months post-AMI) were available. Health status was assessed by four Seattle Angina Questionnaire (SAQ) domain scores (quality of life [QoL], angina frequency [AF], treatment satisfaction [TS], and physical limitation [PL]), as well as SF-12 physical and mental health composite scores (PCS & MCS). We created propensity matched cohorts of CR participants and non-participants to examine the association between CR participation with health status (6 and 12 months) and all-cause mortality (up to 7 years), using conditional repeated measures and proportional hazards models, respectively.
Results: Among 3,957 AMI patients from 31 sites, 2,015 patients (51%) participated in CR after discharge. Compared to non-participants, CR participants were more often Caucasian (83.6% vs. 65.4%), had higher rates of health insurance (90.6% vs. 79.3%), but clinically similar baseline SAQ and SF-12 scores in all domains. After propensity matching, all covariates were well-balanced (Standardized Difference <10 for all patient characteristics) between CR participants and non-participants. In the repeated measures analysis, the mean SAQ and SF-12 domain scores were clinically similar for both groups at 6 and 12 months after hospital discharge (Table). Using a conditional proportional hazards model, a decrease in all-cause mortality was noted in the CR participant group (HR 0.59, 95% CI [0.46, 0.75]).
Conclusion: In a large, multi-center AMI cohort, we found that although CR participation seemed to improve survival, CR participants had similar health status improvements after AMI as non-participants. Further investigation is required to identify how CR programs can further maximize the health status benefits to post-AMI participants.
Author Disclosures: F. Kureshi: B. Research Grant; Significant; supported from National Institutes of Health grant T32HL110837. K.F. Kennedy: None. P.G. Jones: None. R.J. Thomas: None. D.M. Buchanan: None. P. Sharma: None. T. Fendler: None. S.V. Arnold: None. P.M. Ho: None. B.K. Nallamothu: None. J.A. Spertus: B. Research Grant; Significant; PREMIER and TRIUMPH Registries were supported in part by CV Therapeutics Inc, Palo Alto, California, and in part by grant P50 HL077113 from the National Institutes of Health Specialized. F. Ownership Interest; Significant; Seattle Angina Questionnaire.
- © 2014 by American Heart Association, Inc.