Key result
Inpatient cardiac rehabilitation is linked to ~27% lower odds of composite major events vs usual care.
Why the study?
The effectiveness of early 3-week inpatient cardiac rehabilitation compared with usual medical care in patients with coronary heart disease receiving evidence-based secondary preventive medication was evaluated.
Cohort (n=1,474)
Yes
Odds Ratio: 0.729 (95% CI 0.585–0.909)
Absolute Event Rate: 32.6% vs 38.7%
Absolute Risk Reduction: 6.15%
Number Needed to Treat: 17
p-value: p=0.005
May support early inpatient cardiac rehabilitation after coronary events; extends observational data but leaves randomized confirmation open.
BACKGROUND: The aim of this study was to evaluate a 3-week inpatient cardiac rehabilitation (Rehab) started early after the index event in patients with coronary heart disease and evidence-based secondary preventive medication. METHOD: All patients had acute coronary angiography, 679 were discharged from hospital receiving usual care (Hosp), 795 completed a comprehensive Rehab. Follow-up was 12 months. RESULTS: Rehab patients were older (64 vs. 62 years; p < 0.001), had more multivessel disease (51 vs. 37%; p < 0.001), heart failure (64 vs. 40%, p < 0.001), ST-segment elevation myocardial infarction (59 vs. 52%, p = 0.014), and renal insufficiency (10 vs. 7%, p = 0.036). Gender, peripheral artery disease, diabetes, hypertension, and socioeconomic status were similar in groups. Rehab patients had more beta-blockers (88 vs. 75%, p < 0.001) and angiotensin-converting enzyme inhibitors (81 vs. 70%, p < 0.001), a lower low-density lipoprotein cholesterol (102 vs. 122 mg/dl, p < 0.001), and a higher proportion of non-smokers (44 vs. 39%, p = 0.024). Primary combined endpoint of mortality, myocardial infarction (MI), revascularization, and hospitalization occurred in 32.6% of Rehab patients and in 38.7% of Hosp patients [p = 0.014; absolute risk reduction 0.0615, relative risk reduction 16%, number needed to treat (NNT) 17]. Myocardial infarction (MI) (1.8 vs. 3.8%, p = 0.015; NNT 49) and hospitalization (31.8 vs. 38.0%, p = 0.013; NNT 17) were reduced. In multivariate analysis, primary endpoint was reduced significantly (OR 0.729; 95% CI 0.585-0.909; p = 0.005) giving a relative risk reduction of 27% in favour of Rehab. CONCLUSION: Although Rehab patients were sicker at entry, their outcome was substantially improved within 12 months. With very low NNT, Rehab is highly effective and should be advised to all suitable patients with coronary heart disease.
No takes yet. Share an insight, caveat, or question.
Schwaab et al. (2011) conducted a cohort in Coronary heart disease (n=1,474). In-patient cardiac rehabilitation vs. Usual medical care was evaluated on Primary combined endpoint of mortality, myocardial infarction (MI), revascularization, and hospitalization (OR 0.729, 95% CI 0.585-0.909, p=0.005). A 3-week in-patient cardiac rehabilitation program significantly reduced the primary combined endpoint of mortality, myocardial infarction, revascularization, and hospitalization by 27% (OR 0.729) compared to usual medical care over 12 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: