Key result
≥10 outpatient cardiac rehab sessions after ACS linked to ~37% lower mortality vs ≤9 sessions.
Why the study?
Cardiac rehabilitation is effective in ACS, but programmes are not fully implemented, and real-world outpatient practice and dose-effect relationships remain unclear.
Does a higher number of outpatient cardiac rehabilitation sessions reduce all-cause mortality in patients with acute coronary syndrome after percutaneous coronary intervention?
Cohort (n=202,320)
Yes
Does a higher number of outpatient cardiac rehabilitation sessions reduce all-cause mortality in patients with acute coronary syndrome after percutaneous coronary intervention?
Effect estimate: HR 0.63 (95% CI 0.46-0.87)
p-value: p=0.005
In a nationwide Japanese cohort, participating in 10 or more outpatient cardiac rehabilitation sessions after ACS was associated with significantly lower all-cause mortality compared to fewer sessions, regardless of session duration.
OBJECTIVE: Cardiac rehabilitation (CR) is effective in patients with acute coronary syndrome (ACS); however, CR programmes have not been fully implemented. This study aimed to reveal the current practice of outpatient CR and the dose-effect relationship of CR in real-world settings. METHODS: We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with ACS who underwent percutaneous coronary intervention between April 2014 and March 2018 were included. We analysed the implementation rate and dose of outpatient CR and the association between dose and outcomes. RESULTS: Out of 202 320 patients who underwent percutaneous coronary intervention for ACS, a total of 20 444 (10%) underwent outpatient CR. The median (IQR) number of total CR sessions was 9 (3-17), and the median (IQR) duration for each session was 60 (42-60) min. Patients were divided into four groups according to the total number of sessions (≤9 times or ≥10 times) and the duration per session (<50 min or ≥50 min). Compared with the low-number/short-duration group, the adjusted HR for all-cause mortality was 1.00 (95% CI 0.80 to 1.24, p=0.97) in the low-number/long-duration group, 0.63 (95% CI 0.46 to 0.87, p=0.005) in the high-number/short-duration group and 0.74 (95% CI 0.60 to 0.92, p=0.008) in the high-number/long-duration group, respectively. CONCLUSION: We found that the participation rate for outpatient CR after ACS was low and the doses of sessions vary in real-world settings. A higher number of total sessions of outpatient CR is associated with a better prognosis irrespective of the session's duration.
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Kanaoka et al. (2022) conducted a cohort in Acute coronary syndrome (n=202,320). Outpatient cardiac rehabilitation vs. ≤9 sessions, <50 min per session was evaluated on All-cause mortality (HR 0.63, 95% CI 0.46-0.87, p=0.005). Outpatient cardiac rehabilitation with ≥10 sessions after acute coronary syndrome was associated with lower all-cause mortality compared to ≤9 short sessions (HR 0.63; CI 0.46-0.87; p=0.005).
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