What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (ACS) (n=914). Intervention: Incomplete cardiac rehabilitation (<75% of scheduled sessions) vs. Complete cardiac rehabilitation (≥75% of scheduled sessions). Primary outcome: 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).

March 20, 2020Netherlands Heart Journal17 citationsOpen Access

Patients who do not complete cardiac rehabilitation have an increased risk of cardiovascular events during long-term follow-up

Q: What are the key findings of this study?

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).

MSMadoka Sunamura NHNienke ter Hoeve RBRita J. G. van den Berg-Emons

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).

Study Design

Type

Cohort (n=914)

Blinding

Open-label

Multicenter

Yes

Structured PICO

Does incomplete cardiac rehabilitation increase the risk of major adverse cardiac events in post-ACS patients compared to complete cardiac rehabilitation?

Population

914 post-acute coronary syndrome patients scheduled for a 12-week cardiac rehabilitation program, followed for a median of 2.7 years.

Exposure

Incomplete cardiac rehabilitation (defined as participation in <75% of the scheduled physical exercise group sessions of a standard 12-week program).

Comparator

Complete cardiac rehabilitation (defined as participation in ≥75% of the scheduled physical exercise group sessions).

Outcome

Major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction, and coronary revascularisation, at a median follow-up of 2.7 years.composite

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.

Main Result

Hazard Ratio: 2.86 (95% CI 1.47–5.26)

Absolute Event Rate: 11.3% vs 3.8%

Limitations

Potential bias from patients' willingness to participate in a trial (OPTICARE trial cohort)
Study population was at a relatively 'low risk' for drop-out, with relatively young patients without heart failure or renal impairment
Reasons behind incomplete cardiac rehabilitation are unknown
Definition of 'complete CR' only focused on exercise sessions, ignoring other multidisciplinary sessions
Potential bias from patients' willingness to participate in a trial, which may not reflect routine clinical care settings.
Study population was at a relatively 'low risk' for drop-out, with relatively young patients without heart failure or renal impairment.
The reasons behind incomplete cardiac rehabilitation are unknown.
The definition of 'complete CR' only focuses on the number of exercise sessions and does not incorporate other multidisciplinary sessions (e.g., diet, smoking cessation, stress management).

Abstract

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.

Ask AI

Helpful

Bookmark

View Full Paper

Ask AI

Helpful

Bookmark

View Full Paper

Cite This Study

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).

synapsesocial.com/papers/6a8c365ca368e523f2fb3b80 https://doi.org/10.1007/s12471-020-01413-1

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: