Cardiac rehabilitation was associated with a 21% to 34% relative reduction in 5-year mortality compared to nonusers among older Medicare beneficiaries (p < 0.001).
Cohort (n=601,099)
Does cardiac rehabilitation reduce mortality in older Medicare beneficiaries hospitalized for coronary conditions or revascularization?
Cardiac rehabilitation is associated with a 21% to 34% relative reduction in 5-year mortality among older patients hospitalized for coronary conditions, extending the benefits seen in younger trial populations to a broader, real-world demographic.
Effect estimate: Relative reduction 21-34%
p-value: p=<0.001
OBJECTIVES: This study assessed the effects of cardiac rehabilitation (CR) on survival in a large cohort of older coronary patients. BACKGROUND: Randomized controlled trials and meta-analyses have shown that CR improves survival. However, trial participants have been predominantly middle-aged, low- or moderate-risk, white men. METHODS: The population consisted of 601,099 U.S. Medicare beneficiaries who were hospitalized for coronary conditions or cardiac revascularization procedures. One- to 5-year mortality rates were examined in CR users and nonusers using Medicare claims and 3 analytic techniques: propensity-based matching, regression modeling, and instrumental variables. The first method used 70,040 matched pairs, and the other 2 techniques used the entire cohort. RESULTS: Only 12.2% of the cohort used CR, and those users averaged 24 sessions. Each technique showed significantly lower (p < 0.001) 1- to 5-year mortality rates in CR users than nonusers. Five-year mortality relative reductions were 34% in propensity-based matching, 26% from regression modeling, and 21% with instrumental variables. Mortality reductions extended to all demographic and clinical subgroups including patients with acute myocardial infarctions, those receiving revascularization procedures, and those with congestive heart failure. The CR users with 25 or more sessions were 19% relatively less likely to die over 5 years than matched CR users with 24 or fewer sessions (p < 0.001). CONCLUSIONS: Mortality rates were 21% to 34% lower in CR users than nonusers in this socioeconomically and clinically diverse, older population after extensive analyses to control for potential confounding. These results are of similar magnitude to those observed in published randomized controlled trials and meta-analyses in younger, more selected populations.
Suaya et al. (Mon,) conducted a cohort in Coronary conditions or cardiac revascularization (n=601,099). Cardiac rehabilitation vs. Nonusers was evaluated on 1- to 5-year mortality (Relative reduction 21-34%, p=<0.001). Cardiac rehabilitation was associated with a 21% to 34% relative reduction in 5-year mortality compared to nonusers among older Medicare beneficiaries (p < 0.001).