The role of cardiac rehabilitation in patients following acute coronary syndrome

Abstract Funding Acknowledgements None. Introduction The benefits of cardiac rehabilitation in patients with acute coronary syndrome (ACS) are well established. Although there are limited centres with cardiac rehabilitation and patients, especially from peripheral hospitals, wait a long time to enter the programme and many of them don’t even enter these programmes. Purpose Characterize the patient population that go to cardiac rehabilitation and evaluate short- and long-term outcomes. Methods Multicenter retrospective study, patients with the diagnosis of ACS and data collected from 1/01/2015 to 31/12/2021. Patients were divided into 2 groups (G). G1 – Patients with cardiac rehabilitation programmed and/or planned; G2 – Patients not referenced for cardiac rehabilitation. We further analyse patients according to MACE events, group A without MACE; group B with MACE. Results 11992 patients were enrolled, only 3162 (26.4%) patients were referenced for cardiac rehabilitation. G1 was younger 63.5 ± 12.4 (p0.001), had more males 76.7% (p0.001) and more smokers 38.0% vs 25.3% (p0.001), but less patients with arterial hypertension (AH) 65.1% vs 70.9% (p0.001), diabetes mellitus (DM) 29.5% vs 32.8% (p0.001), dyslipidemia 57.0% vs 61.2% (p0.001), previous heart failure 4.8% vs 7.9% (p0.001) and chronic kidney disease (CKD) 3.8% vs 7.3% (p0.001). G1 had although more patients with symptoms of angina 29.2% vs 23.3% (p0.001) and previous MI 20.5% vs 17.6% (p0.001). Regarding MACE events G1 had better outcomes 1.3% vs 6.1% (p0.001). Considering MACE events, group B was older 74±12 years (p0.001), male gender was predominant (62.5%) and had more patients with AH 76.9% vs 68.8% (p0.001), DM 45.1% vs 31.1% (p0.001), CKD 14.6% vs 5.6% (p0.001) and pacemaker (PM) or ICD devices 3.8% vs 1.7% (p0.001). Independent predictors of MACE achieved through logistic regression analysis are gender p0.001, OR 0.325, CI (95%) 0.158-0.672; CKD p= 0.042, OR 4.027, CI 1.019-15.911; time from symptoms to 1st contact ≥ 120min p=0.032, OR 2.088, CI 1.067-4.087; usage of inotropic medications p0.001, OR 6.383, CI 2.995-13.602; left ventricular ejection fraction 30% vs ≥30% p=0.002, OR 4.172, CI 1.722-10.108; need of invasive mechanical ventilation p0.001, OR 6.593, CI 2.812-15.457 and need of temporary PM p0.001, OR 12.372, CI 4.025-38.031. Conclusion In these study population, patients with less cardiovascular (CV) risk factors and comorbidities were more often assigned to cardiac rehabilitation programmes. Not unpredictable patients with more comorbidities suffered more from MACE events. Survival analysis also showed that CV mortality and re-admission at 1 year were higher in patients not assigned for cardiac rehabilitation.