What is the clinical evidence from this study?

Study design: Observational. Population: Acute Myocardial Infarction (n=12061). Intervention: In-hospital cardiac rehabilitation vs. No participation. Primary outcome: Hospital-associated disability (≥5-point decrease in Barthel index at discharge) (OR 0.737, 95% CI 0.567-0.960, p=0.023).

December 13, 2024Open Access

Association of In-Hospital Cardiac Rehabilitation on Hospital-Associated Disability for Octogenarian Patients With Acute Myocardial Infarction　― An Insight From the JROAD-DPC Database ―

YKYuji KonoFujita Health University SKSatoshi KatanoSapporo Medical University YOYohei OtakaFujita Health University

Key Result

Higher daily amounts of in-hospital cardiac rehabilitation independently reduced the risk of hospital-associated disability in octogenarian patients with acute myocardial infarction (OR 0.737).

Study Design

Type

Observational (n=12,061)

Multicenter

Yes

Structured PICO

Does in-hospital cardiac rehabilitation prevent hospital-associated disability in octogenarian patients with acute myocardial infarction?

Population

12,061 patients aged >80 years (median age 83, 63.3% male) hospitalized with acute myocardial infarction (AMI) who underwent emergency percutaneous coronary intervention (PCI), from the Japanese JROAD-DPC database.

Intervention

In-hospital cardiac rehabilitation (CR) categorized by daily amount: Low (20-30 min), Moderate (30-40 min), and High (>40 min).

Comparator

No participation in in-hospital cardiac rehabilitation (NA group).

Outcome

Hospital-associated disability (HAD), defined as a ≥5-point decrease in Barthel index (BI) score at discharge compared with admission.patient reported

Higher daily amounts of in-hospital cardiac rehabilitation are independently associated with a reduced risk of hospital-associated disability in octogenarian patients with acute myocardial infarction.

Main Result

Effect estimate: OR 0.737 (95% CI 0.567-0.960)

p-value: p=0.023

Limitations

Exclusion of patients with missing Barthel index data at admission may introduce selection bias
Retrospective design leaves potential residual bias from unmeasured confounders such as AMI severity and CR program details
Subitems of the Barthel index are unclear, making it unknown which specific items are likely to decline
Absence of pre-admission Barthel index scores required relying on admission scores as a proxy

Abstract

Background: This study aimed to determine the status of in-hospital cardiac rehabilitation (CR) and hospital-associated disability (HAD) for patients with acute myocardial infarction (AMI) aged >80 years. Methods and Results: This study involved the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination databases, and included patients who were hospitalized with AMI from April 2014 to March 2021. Patients were categorized by the daily amount of CR: NA, not applicable; Low, 20-30 min; Moderate, 30-40 min; and High, >40 min. Activities of daily living were assessed using the Barthel index (BI) score, and evaluated at both admission and discharge. This study defined HAD as a ≥5-point decrease in BI score at discharge compared with admission. A total of 12,061 eligible patients were selected (age 83.0 years; 36.4% female), of which 2.7% had HAD (NA, 2.0%; Low, 4.7%; Moderate, 2.6%; High, 2.6%). The Low group was more likely to develop HAD. Chronological trends in hospital stay and incidence rate of HAD gradually decreased with the increased in-hospital CR participation rate. The multivariable logistic regression analysis revealed that the daily amount of CR was selected as an independent associated factor for preventing HAD (odds ratio 0.737; 95% confidence interval 0.567-0.960; P=0.023). Conclusions: Our results revealed that higher amounts of in-hospital CR for patients with AMI should be performed, especially in octogenarians.

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