April 25, 2018European Heart Journal - Quality of Care and Clinical Outcomes137 citationsOpen Access
Cardiac rehabilitation fitness changes and subsequent survival
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Key Result
Non-response and low-response in cardiorespiratory fitness after cardiac rehabilitation were associated with significantly higher mortality compared with high-response (22% and 17% vs. 8%; P<0.001).
Study Design
Type
Cohort (n=1,171)
Structured PICO
Does the level of improvement in cardiorespiratory fitness after cardiac rehabilitation predict mortality in patients with coronary heart disease?
P
Population
1171 coronary heart disease (CHD) patients referred for a phase II cardiac rehabilitation programme after therapy for an acute coronary syndrome, coronary artery bypass graft procedure or a percutaneous coronary intervention
I
Intervention
Phase II cardiac rehabilitation programme, with patients stratified as high-responders (HighRes) based on absolute improvements in cardiorespiratory fitness (CRF)
C
Comparator
Low-responders (LowRes) and non-responders (NonRes) in cardiorespiratory fitness after the same cardiac rehabilitation programme
O
Outcome
Mortality after 0.5-13.4 years of follow-up (mean 6.4 years)hard clinical
Lack of improvement in cardiorespiratory fitness following cardiac rehabilitation is associated with significantly higher long-term mortality in patients with coronary heart disease.
Main Result
Effect estimate: three-fold higher mortality
Absolute Event Rate: 8% vs 22%
p-value: p=<0.001
Abstract
Aims: Assessments of cardiac rehabilitation (CR) in coronary heart disease (CHD) cohorts usually examine mortality in aggregate. This study examines the prognosis and characteristics of patients who enrolled and completed CR, stratified by their level of improvement in cardiorespiratory fitness (CRF) by examining the characteristics, outcomes and predictors of non-response in CRF (NonRes) compared with low-responders (LowRes) and high-responders (HighRes) after CR. Methods and results: A total of 1171 CHD patients were referred for a phase II CR programme after therapy for an acute coronary syndrome, coronary artery bypass graft procedure or a percutaneous coronary intervention between 1 January 2000 and 30 June 2013 underwent cardiopulmonary exercise testing before and after CR. This cohort was divided according to absolute improvements in CRF (i.e. change in peak oxygen consumption expressed in mL⋅kg-1⋅min-1). Mortality was analysed after 0.5-13.4 years of follow-up (mean 6.4 years). A total of 266 (23%) subjects were NonRes. After adjustment for body mass index, age, gender, left ventricular ejection fraction and baseline CRF, NonRes, and LowRes had a statistically significant three-fold and two-fold higher mortality, respectively, when compared with HighRes (HighRes 8% vs. LowRes 17% vs. NonRes 22%; P < 0.001). Age, female gender, baseline CRF, hostility, and presence of diabetes were significant predictors of NonRes and LowRes. In addition, higher waist circumference was a predictor of NonRes. Conclusion: Significant proportions of subjects referred to CR have no/low improvement in CRF and higher associated mortality risks. Greater attention is required to increase improvements in CRF following CR and avoid NonRes.
Cite This Study
Schutter et al. (2018) conducted a cohort in Coronary heart disease (n=1,171). High improvement in cardiorespiratory fitness (HighRes) after cardiac rehabilitation vs. Non-response (NonRes) or low-response (LowRes) in cardiorespiratory fitness was evaluated on Mortality (three-fold higher mortality, p=<0.001). Non-response and low-response in cardiorespiratory fitness after cardiac rehabilitation were associated with significantly higher mortality compared with high-response (22% and 17% vs. 8%; P<0.001).