Key result
Patients with acute coronary syndrome who did not complete a 12-week cardiac rehabilitation program had a significantly higher incidence of major adverse cardiac events compared to those who completed it (11.3% vs 3.8%, aHR 2.86).
Why the study?
Cardiac rehabilitation has favourable effects on cardiovascular mortality and morbidity, making it reasonable to expect that incomplete participation results in suboptimal patient outcomes.
Does incomplete cardiac rehabilitation increase the risk of major adverse cardiac events in post-ACS patients compared to complete cardiac rehabilitation?
Cohort (n=914)
Open-label
Yes
Does incomplete cardiac rehabilitation increase the risk of major adverse cardiac events in post-ACS patients compared to complete cardiac rehabilitation?
Incomplete participation in a standard 12-week cardiac rehabilitation program following acute coronary syndrome is associated with a significantly increased risk of major adverse cardiac events during long-term follow-up.
Incomplete cardiac rehabilitation may identify higher-risk post-ACS patients; leaves open causality versus confounding in observational data.
BACKGROUND: Cardiac rehabilitation (CR) has favourable effects on cardiovascular mortality and morbidity. Therefore, it might reasonable to expect that incomplete CR participation will result in suboptimal patient outcomes. METHODS: We studied the 914 post-acute coronary syndrome patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE) trial. They all started a 'standard' CR programme, with physical exercises (group sessions) twice a week for 12 weeks. Incomplete CR was defined as participation in <75% of the scheduled exercise sessions. Patients were followed-up for 2.7 years, and the incidence of cardiac events was recorded. Major adverse cardiac events (MACE) included all-cause mortality, non-fatal myocardial infarction and coronary revascularisation. RESULTS: A total of 142 (16%) patients had incomplete CR. They had a higher incidence of MACE than their counterparts who completed CR (11.3% versus 3.8%, adjusted hazard ratio [aHR] 2.86 and 95% confidence interval [CI] 1.47-5.26). Furthermore, the incidence of any cardiac event, including MACE and coronary revascularisation, was higher (20.4% versus 11.0%, aHR 1.54; 95% CI 0.98-2.44). Patients with incomplete CR were more often persistent smokers than those who completed CR (31.7% versus 11.5%), but clinical characteristics were similar otherwise. CONCLUSION: Post-ACS patients who did not complete a 'standard' 12-week CR programme had a higher incidence of adverse cardiac events during long-term follow-up than those who completed the programme. Since CR is proven beneficial, further research is needed to understand the reasons why patients terminate prematurely.
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Sunamura et al. (2020) conducted a cohort in Acute coronary syndrome (ACS) (n=914). Incomplete cardiac rehabilitation (<75% of scheduled sessions) vs. Complete cardiac rehabilitation (≥75% of scheduled sessions) was evaluated on Major adverse cardiac events (MACE), including all-cause mortality, non-fatal myocardial infarction, and coronary revascularisation (aHR 2.86, 95% CI 1.47-5.26). Patients with acute coronary syndrome who did not complete a 12-week cardiac rehabilitation program had a significantly higher incidence of major adverse cardiac events compared to those who completed it (11.3% vs 3.8%, aHR 2.86).
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