A history of heart failure was associated with lower cardiac rehabilitation attendance compared to patients with no heart failure and normal LVEF (61.8% vs 82.7%; HR 0.82, 95% CI 0.78-0.85).
Observational (n=72,977)
Yes
Patients with a history of heart failure or new-onset LVEF impairment post-MI, as well as socioeconomically disadvantaged patients, have significantly lower attendance rates in cardiac rehabilitation.
Effect estimate: HR 0.82 (95% CI 0.78-0.85)
Absolute Event Rate: 61.8% vs 82.7%
Abstract Background Participation in comprehensive cardiac rehabilitation (CR) in general, and exercise-based CR (EBCR) in particular, is strongly advocated for patients with myocardial infarction (MI) and for those with heart failure (HF). Despite well-documented benefits, attendance remains low due to barriers at multiple levels. Purpose We aimed to describe determinants of attendance in comprehensive CR and EBCR for patients with MI and i) no history of HF and normal (≥50%) left ventricular ejection fraction (LVEF) post-MI, ii) no history of HF and new LVEF reduction (50%) post-MI and iii) history of HF (irrespective of LVEF pre/post-MI). Methods In this retrospective observational study, patients 80 years of age registered in the Swedish cardiac registry SWEDEHEART with a MI diagnosis 2010-2019 were included. Patient- and system-level determinants of attendance in CR and EBCR were assessed using adjusted Cox proportional hazards and binary logistic regression models, respectively. Results Out of the 72,977 included patients (median age 64 IQR 57-69 years, 74% men), 59.3% (n=43,289) had no history of HF and normal LVEF at discharge, 34.3% (n=25,032) had no history HF but developed reduced LVEF post-MI, and 6.4% (n=4676) had a history of HF. Proportion of patients attending CR was highest in patients with no HF history and normal LVEF (82.7%) and lowest in patients with a history of HF (61.8%, Figure 1). Of all MI patients with a history of HF, 19.6% attended EBCR. Compared to patients with no history of HF and normal LVEF, those with new LVEF reduction and those with a history of HF were less likely to attend CR (hazards ratio 95% confidence interval: 0.97 0.95-0.99 and 0.82 0.78-0.85) and EBCR (0.90 0.87-0.94 and 0.75 0.67-0.83). Patients with lower income, younger patients, women, those born outside of Sweden, prior and current smokers, patients with comorbidities and those living far from the CR centre were less likely to attend CR (Figure 2, Panel A). Among those attending CR, low income and educational level, having no partner, being an active smoker, having comorbidities and living far from the CR centre were associated with lower EBCR attendance (Figure 2, Panel B). Belonging to a small hospital or university hospital predicted higher attendance in both comprehensive CR and EBCR across all groups. No major differences in determinants of attendance were observed between the three strata based on HF and LVEF (data not shown). Conclusion Compared to patients with no history of HF and normal LVEF, CR and EBCR attendance was lower in those with new-onset impairment of LVEF as well as in patients with a history of HF. Additionally, socioeconomically disadvantaged patients and those with comorbidities had the lowest attendance across all groups. Efforts to increase attendance in CR and EBCR in these vulnerable groups should be a priority.Attendance in CR and EBCR Determinants of attendance in CR, EBCR
Brudasca et al. (Sat,) conducted a observational in Myocardial infarction (n=72,977). History of heart failure vs. No history of heart failure and normal LVEF was evaluated on Attendance in comprehensive cardiac rehabilitation (HR 0.82, 95% CI 0.78-0.85). A history of heart failure was associated with lower cardiac rehabilitation attendance compared to patients with no heart failure and normal LVEF (61.8% vs 82.7%; HR 0.82, 95% CI 0.78-0.85).