Key result
Attending Heart School during cardiac rehabilitation after first-time myocardial infarction was associated with a lower risk of five-year all-cause mortality (HR 0.62; 95% CI 0.55-0.69).
Why the study?
Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden, but an evaluation with respect to mortality was lacking.
Does attending Heart School reduce all-cause and cardiovascular mortality in patients with first-time myocardial infarction?
Cohort (n=47,907)
Yes
Does attending Heart School reduce all-cause and cardiovascular mortality in patients with first-time myocardial infarction?
Hazard Ratio: 0.62 (95% CI 0.55–0.69)
Participation in a group-based educational intervention (Heart School) during cardiac rehabilitation is associated with a significant reduction in long-term all-cause and cardiovascular mortality after a first myocardial infarction.
Heart School attendance may link to halved post-MI mortality; leaves open causality and need for randomized trials.
BACKGROUND: The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking. AIMS: Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction. METHODS: Patients with first-time myocardial infarction (<75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006-2015), with >99% complete follow-up in the Causes of Death registry for outcome events. Of 192,059 myocardial infarction admissions, 47,907 unique patients with first-time myocardial infarction surviving to the first cardiac rehabilitation visit constituted the study population. The exposure was attending Heart School at the first cardiac rehabilitation visit 6-10 weeks post-myocardial infarction. Data on socioeconomic status was acquired from Statistics Sweden. After multiple imputation, propensity score matching was performed. The association of exposure with mortality was estimated with Cox regression and survival curves. RESULTS: After matching, attending Heart School was associated (hazard ratio (95% confidence interval)) with a markedly lower risk of both all-cause (two-year hazard ratio = 0.53 (0.44-0.64); five-year hazard ratio = 0.62 (0.55-0.69)) and cardiovascular (0.50 (0.38-0.65); 0.57 (0.47-0.69)) mortality. The results were robust in several sensitivity analyses. CONCLUSIONS: Attending Heart School during cardiac rehabilitation is associated with almost halved all-cause and cardiovascular mortality after first-time myocardial infarction. The result warrants further investigation through adequately powered randomised trials.
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Wallert et al. (2019) conducted a cohort in first-time myocardial infarction (n=47,907). Heart School attendance was evaluated on five-year all-cause mortality (HR 0.62, 95% CI 0.55-0.69). Attending Heart School during cardiac rehabilitation after first-time myocardial infarction was associated with a lower risk of five-year all-cause mortality (HR 0.62; 95% CI 0.55-0.69).
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