Key result
Inpatient cardiac rehabilitation was strongly associated with subsequent outpatient cardiac rehabilitation participation (adjusted OR 17.01) among older post-operative cardiac patients, though overall outpatient participation remained low at 9.0%.
Why the study?
Although outpatient cardiac rehabilitation is effective, participation rates and associated factors among older cardiac patients remain unclear in real-world settings.
What is the proportion of and what factors are associated with outpatient cardiac rehabilitation participation among older patients with heart diseases after cardiac intervention?
Cohort (n=690)
Yes
What is the proportion of and what factors are associated with outpatient cardiac rehabilitation participation among older patients with heart diseases after cardiac intervention?
Outpatient cardiac rehabilitation participation among older post-operative cardiac patients in Japan is highly suboptimal at 9.0%, highlighting a critical gap in secondary prevention.
Low outpatient cardiac rehabilitation participation (9%) signals a persistent care gap; leaves open whether inpatient programs improve uptake in older patients.
BACKGROUND: Although outpatient cardiac rehabilitation has been shown to be effective, the participation status of older cardiac patients is unclear in real-world settings. We investigated the proportion and associated factors of outpatient cardiac rehabilitation participation among older patients with heart diseases after cardiac intervention. METHODS: We analyzed data from medical and long-term care insurance claims data from two municipalities in Japan. The data coverage period was between April 2014 and March 2019 in City A and between April 2012 and November 2016 in City B. We identified patients aged ≥65 years with post-operative acute myocardial infarction, angina pectoris, or heart valve disease. We estimated the proportion of cardiac rehabilitation participation and conducted logistic regression to identify factors (age, sex, type of cardiac disease, open-heart surgery, Charlson comorbidity index, long-term care need level, catecholamine use, inpatient cardiac rehabilitation, and hospital volume for cardiac rehabilitation) associated with outpatient cardiac rehabilitation participation. RESULTS: A total of 690 patients were included in this study. The proportion of patients receiving outpatient cardiac rehabilitation was 9.0% overall. Multivariable logistic regression analysis suggested that men (adjusted OR 3.98; 95% CI 1.69-9.37), acute myocardial infarction (adjusted OR 2.76; 95% CI 1.20-6.36; reference angina pectoris), inpatient cardiac rehabilitation (adjusted OR 17.01; 95% CI 5.33-54.24), and "hospital volume" for cardiac rehabilitation (adjusted OR 4.35; 95% CI 1.14-16.57 for high-volume hospitals; reference low-volume hospital) were independently associated with outpatient cardiac rehabilitation. CONCLUSIONS: The participation rate of outpatient cardiac rehabilitation among older post-operative cardiac patients was suboptimal. Further studies are warranted to examine its generalizability and whether a targeted approach to a group of patients who are less likely to receive outpatient cardiac rehabilitation could improve the participation rate.
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Komiyama et al. (2022) conducted a cohort in Post-operative heart disease (acute myocardial infarction, angina pectoris, or heart valve disease) (n=690). Inpatient cardiac rehabilitation vs. No inpatient cardiac rehabilitation was evaluated on Outpatient cardiac rehabilitation participation within 5 months post-discharge (adjusted OR 17.01, 95% CI 5.33-54.24, p=<0.001). Inpatient cardiac rehabilitation was strongly associated with subsequent outpatient cardiac rehabilitation participation (adjusted OR 17.01) among older post-operative cardiac patients, though overall outpatient participation remained low at 9.0%.
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