Key result
Cardiac rehabilitation linked to ~47% lower mortality but higher MI readmissions in ACS survivors.
Why the study?
The study was conducted to compare 3-year clinical outcomes between survivors of acute coronary syndrome who attended cardiac rehabilitation programs and those who did not.
Does attendance at cardiac rehabilitation programs reduce mortality and readmissions in survivors of acute coronary syndrome?
Does attendance at cardiac rehabilitation programs reduce mortality and readmissions in survivors of acute coronary syndrome?
Participation in cardiac rehabilitation after ACS is associated with a 47% reduction in 3-year all-cause mortality, highlighting its critical role in secondary prevention despite an observed increase in MI readmissions.
CR attendance linked to lower mortality yet higher MI readmissions in ACS survivors; leaves open net benefit, needing randomized confirmation.
Purpose: This study aimed to compare 3-year outcomes between survivors of acute coronary syndrome (ACS) who did and did not attend cardiac rehabilitation (CR) programs. Methods: This follow-up study of the SNAPSHOT ACS audit included 1069 patients across Australia. Clinical data were linked to hospitalizations, mortality, and pharmacotherapy dispensing datasets for people hospitalized with ACS and analyzed in the 3 years following index admission. Outcomes were all-cause mortality and readmissions for myocardial infarction (MI), stroke, and heart failure. Results: The cohort was aged 67 ± 13 years, 66% male, 57% had a discharge diagnosis of MI, and 36% attended CR. Attendees of CR were younger (65 ± 11 vs 69 ± 13 years, P <.001), more likely to be male (72% vs 63%, P =.002) and receive revascularization interventions (percutaneous coronary intervention: 48% vs 29%, P <.001; coronary artery bypass graft surgery: 14% vs 4.4%, P <.001), and less likely to have a history of MI (23% vs 30%, P =.014) than nonattendees. Compared with nonattendees, attendees of CR had a lower risk of all-cause mortality (HR = 0.53: 95% CI, 0.31-0.88) but a greater risk of MI readmissions (HR = 1.82: 95% CI, 1.28-2.59) over 3-year follow-up. There was no significant difference in the hazard of stroke and heart failure between attendees and nonattendees. The prescription of ≥3 guideline-indicated medications was higher in attendees of CR at all time points. Conclusions: Participation in CR among survivors of ACS was associated with reduced all-cause mortality and increased MI readmissions across 3 years post-discharge. The findings underscore the importance of systematic secondary prevention strategies to mitigate mortality risks after ACS.
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Hyun et al. (2026) studied this question. Cardiac rehabilitation participation reduced all-cause mortality by 47% (HR = 0.53) but increased myocardial infarction readmissions (HR = 1.82) in ACS survivors over 3 years.
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