Participation in a comprehensive cardiac rehabilitation program improves mid- and long-term prognosis in survivors of acute coronary syndrome

Background: Cardiovascular disease is the leading cause of death in developed nations. While survival rates of myocardial infarction have improved in recent decades due to advanced treatment options, secondary prevention efforts are often neglected. This study evaluates the effects of participation in a comprehensive cardiac rehabilitation program (CCR) on survival in patients presenting with acute coronary syndrome (ACS). Methods: In Hungary, since January 2014, data on patients with ACS have been mandatorily entered into the National Myocardial Infarction Register. This Register now holds information on 155,000 ACS events involving over 130,000 patients. A retrospective analysis was performed on the data of said Register. Results: We examined data on 76,153 ACS cases that occurred from 2014 to 2019. For the purposes of this study, we focused on early survivors, and 66,905 patients were included in our analysis (alive 30 days after the index event). The main modifiable protective factors, analyzed by binary regression model, were percutaneous coronary intervention (PCI), direct admission to a PCI-capable hospital, and participation in a comprehensive cardiac rehabilitation (CCR) program. In Hungary, such programs include supervised physical exercise as well as patient education on smoking cessation, dietary changes, and medication compliance. Our study showed that participation in CCR programs was associated with a 42 % reduction in 1-year mortality for patients with ST-elevation myocardial infarction (STEMI) and improved long-term survival rates across various patient subgroups. Despite its efficacy, the participation rate in CCR was low, with only 21 % of eligible patients completing such programs. The lowest CCR participation rate was in non-ST-elevation myocardial infarction (NSTEMI) patients who did not undergo PCI; these patients also had the highest mortality rates. Factors predicting lower participation rates were older age, male gender, NSTEMI presentation, and lack of percutaneous coronary intervention (PCI). Conclusion and relevance: This study shows a significant survival benefit of participation in a comprehensive cardiac rehabilitation program in early survivors of ACS. Unexpectedly, this finding was contrasted by a very low participation rate in this highly effective and cost-effective intervention. Increasing awareness of CCR's benefits both amongst patients and providers, as well as increasing access to and availability of CCR should significantly improve survival rates following ACS.