January 1, 2010Open Access

Effects of Phase III Cardiac Rehabilitation on Mortality and Cardiovascular Events in Elderly Patients With Stable Coronary Artery Disease

TOTomo OnishiTeikyo University of Science KSKazunori ShimadaKanazawa University HSHiroyuki SatoTokyo Medical and Dental University

Structured PICO

Does phase III cardiac rehabilitation reduce mortality and cardiovascular events in elderly male patients with stable coronary artery disease?

Population

n=111 elderly male patients (≥65 years) with stable coronary artery disease (CAD), referred at least 6 months after a major coronary event (ACS, CABG, or PCI). Excluded: ongoing congestive heart failure, liver dysfunction, renal dysfunction, or systemic disease.

Intervention

Phase III comprehensive cardiac rehabilitation (CR) program once weekly for 6 months (supervised exercise, dietary, and education program) plus home-based aerobic and resistance exercise twice weekly.

Comparator

Standard outpatient care (age-matched controls selected from medical records, medical treatment unchanged during the 6 months).

Outcome

Composite of all-cause death or major adverse cardiovascular events (MACE), including cardiovascular death, acute coronary syndrome, refractory ischemia requiring PCI or CABG, admission for congestive heart failure, and stroke, followed for up to 3,500 days.composite

Phase III cardiac rehabilitation significantly reduces the long-term risk of major adverse cardiovascular events in elderly male patients with stable coronary artery disease.

Abstract

BACKGROUND: Cardiac rehabilitation (CR) has numerous benefits, including reduction of mortality and cardiovascular events, in patients with coronary artery disease (CAD). However, the long-term effect of phase III CR in elderly patients with stable CAD is still unknown. METHODS AND RESULTS: The 111 elderly male CAD patients (>or=65 years), including 37 subjects participating in supervised CR for 6 months and 74 age-matched controls, were analyzed. The patients were followed for up to 3,500 days, until the occurrence of death or 1 of the following major adverse cardiovascular events (MACE): cardiovascular death, acute coronary syndrome, refractory angina requiring revascularization, admission for congestive heart failure, or stroke. All-cause mortality tended to be lower in the CR group than in the Control group (14% vs 28%, P=0.081). The MACE incidence was significantly lower in the CR group than in the Control group (30% vs 62%, P=0.001). Multivariate Cox proportional hazard analysis showed that the MACE incidence was significantly lower in the CR group than in the Control group adjusted hazard ratio 0.43 (95% confidence interval 0.20-0.91), P=0.027. CONCLUSIONS: Phase III CR has the beneficial effect of reducing cardiovascular events even in elderly patients with stable CAD.

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