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. 2014 Jun;127(6):538-46.
doi: 10.1016/j.amjmed.2014.02.008. Epub 2014 Feb 18.

Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction

Shannon M Dunlay  1 , Quinn R Pack  2 , Randal J Thomas  3 , Jill M Killian  4 , Véronique L Roger  5
Affiliations

Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction

Shannon M Dunlay et al. Am J Med. 2014 Jun.

Abstract

Background: Participation in cardiac rehabilitation has been shown to decrease mortality after acute myocardial infarction, but its impact on readmissions requires examination.

Methods: We conducted a population-based surveillance study of residents discharged from the hospital after their first-ever myocardial infarction in Olmsted County, Minnesota, from January 1, 1987, to September 30, 2010. Patients were followed up through December 31, 2010. Participation in cardiac rehabilitation after myocardial infarction was determined using billing data. We used a landmark analysis approach (cardiac rehabilitation participant vs not determined by attendance in at least 1 session of cardiac rehabilitation at 90 days post-myocardial infarction discharge) to compare readmission and mortality risk between cardiac rehabilitation participants and nonparticipants accounting for propensity to participate using inverse probability treatment weighting.

Results: Of 2991 patients with incident myocardial infarction, 1569 (52.5%) participated in cardiac rehabilitation after hospital discharge. The cardiac rehabilitation participation rate did not change during the study period, but increased in the elderly and decreased in men and younger patients. After adjustment, cardiac rehabilitation participants had lower all-cause readmission (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.65-0.87; P < .001), cardiovascular readmission (HR, 0.80; 95% CI, 0.65-0.99; P = .037), noncardiovascular readmission (HR, 0.72; 95% CI, 0.61-0.85; P < .001), and mortality (HR, 0.58; 95% CI, 0.49-0.68; P < .001) risk.

Conclusions: Cardiac rehabilitation participation is associated with a markedly reduced risk of readmission and death after incident myocardial infarction. Improving cardiac rehabilitation participation rates may have a large impact on post-myocardial infarction healthcare resource use and outcomes.

Keywords: Cardiac rehabilitation; Epidemiology; Myocardial infarction; Readmission; Survival.

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Figures

Figure 1
Figure 1. Cardiac Rehabilitation Participation According to Age and Sex
The proportion of patients participating in cardiac rehabilitation by year of myocardial infarction diagnosis according to age (panel A, elderly if age≥65 years) and sex (panel B) are shown.
Figure 1
Figure 1. Cardiac Rehabilitation Participation According to Age and Sex
The proportion of patients participating in cardiac rehabilitation by year of myocardial infarction diagnosis according to age (panel A, elderly if age≥65 years) and sex (panel B) are shown.
Figure 2
Figure 2. Timing of Participation in Cardiac Rehabilitation
The number of days after incident myocardial infarction hospital discharge that patients attended their first session of cardiac rehabilitation is shown.
Figure 3
Figure 3. Readmission and Mortality After Myocardial Infarction for Cardiac Rehabilitation Participants and Non-Participants
The estimated mean number of readmissions over time (A) and Kaplan Meier curves demonstrating time to death (B) after myocardial infarction are shown for cardiac rehabilitation participants and non-participants. The number of patients at risk is shown below the figures.
Figure 3
Figure 3. Readmission and Mortality After Myocardial Infarction for Cardiac Rehabilitation Participants and Non-Participants
The estimated mean number of readmissions over time (A) and Kaplan Meier curves demonstrating time to death (B) after myocardial infarction are shown for cardiac rehabilitation participants and non-participants. The number of patients at risk is shown below the figures.
Figure 4
Figure 4. Risk of Readmission and Death According to Baseline Characteristics
The HR (95% CI) for readmission (A) and death (B) according to patient baseline characteristics are shown.
Figure 4
Figure 4. Risk of Readmission and Death According to Baseline Characteristics
The HR (95% CI) for readmission (A) and death (B) according to patient baseline characteristics are shown.
See this image and copyright information in PMC

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