July 9, 2008Open Access
View Full PaperCardiac rehabilitation: health characteristics and socio-economic status among those who do not attend
Key Result
Cardiac rehabilitation attendance was associated with significantly lower 2-year mortality compared to non-attendance (2.8% vs 21.8%, P<0.0001) among patients surviving 30 days post-myocardial infarction.
Study Design
Type
Cohort (n=200)
Structured PICO
Does attendance at a comprehensive cardiac rehabilitation programme improve 2-year mortality and invasive treatment rates in MI survivors compared to non-attendance?
P
Population
200 consecutive myocardial infarction patients aged 30-69 years who survived 30 days post-admission, followed for 2 years.
E
Exposure
Comprehensive cardiac rehabilitation (CR) programme (attended by n=145, 72.5%).
C
Comparator
Non-attendance to cardiac rehabilitation (n=55).
O
Outcome
2-year mortality, re-admission, and invasive treatment, as well as predictors of CR-attendance.hard clinical
Non-attendance to cardiac rehabilitation after MI is associated with significantly higher 2-year mortality, which is partly driven by the selection of healthier patients and socioeconomic factors.
Main Result
Absolute Event Rate: 2.8% vs 21.8%
p-value: p=<0.0001
Limitations
- Selection bias (selection of healthy patients for cardiac rehabilitation may partly explain the mortality difference)
Abstract
BACKGROUND: Cardiac rehabilitation (CR) is well documented, in randomised trials, to reduce mortality risk after myocardial infarction (MI). Selection of healthy patients for CR is a relatively unexplored problem. Our aims were to identify predictors of CR-attendance and to describe the prognosis as concerns mortality, re-admission and invasive treatment among CR-attendees as compared to CR-non-attendees. METHODS: From a cohort of 138 290 persons aged 30-69 years, we identified consecutive MI patients, between 1 April 2000 and 31 March 2002. There were 206 MI patients, who survived until admission, and among the 200 who survived 30 days, 145 (72.5%) attended a comprehensive CR programme. Data were obtained from patient charts and from Danish population registers, and as a result we had no non-participation for the study. RESULTS: The 2-year mortality proportions for patients surviving the first 30 days of admission were 2.8 and 21.8% among CR-attendees and CR-non-attendees, respectively (P < 0.0001). Among CR-non-attendees, there was a smaller fraction having an invasive treatment performed as compared with CR-attendees. By multiple logistic regression controlling for age and sex, CR-attendance was associated with chest pain, whereas CR-non-attendance was associated with low gross income, single living and inverted T-wave in the electrocardiogram. CONCLUSION: CR attendance rate was 72.5%. Non-attendees have a higher mortality risk, which in part may be attributed to selection of healthy patients. Non-attendees are older and more likely to have atypical symptoms at admission, a low socioeconomic status and to live alone. Special attention is needed to improve CR attendance among such patients.