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. 2020 Mar 2;3(3):e201396.
doi: 10.1001/jamanetworkopen.2020.1396.

Association of Cardiac Rehabilitation With Survival Among US Veterans

Nirupama Krishnamurthi  1   2 , David W Schopfer  1   3 , Hui Shen  1   3 , Mary A Whooley  1   3   4
Affiliations

Association of Cardiac Rehabilitation With Survival Among US Veterans

Nirupama Krishnamurthi et al. JAMA Netw Open. .

Abstract

Importance: Participation in cardiac rehabilitation (CR) programs at Veterans Affairs (VA) facilities is low. Most veterans receive CR through purchased care at non-VA programs. However, limited literature exists on the comparison of outcomes between VA and non-VA CR programs.

Objective: To compare 1-year mortality and 1-year readmission rates for myocardial infarction or coronary revascularization between VA vs non-VA CR participants.

Design, setting, and participants: This cohort study included 7320 patients hospitalized for myocardial infarction or coronary revascularization at the VA between 2010 and 2014 who did not die within 30 days of discharge and who participated in 2 or more CR sessions after discharge. The study excluded individuals hospitalized for ischemic heart disease after December 2014 when the VA Choice Act changed referral criteria for non-VA care. Data analysis was performed from November 2019 to January 2020.

Exposures: Participation in 2 or more CR sessions within 12 months of discharge at a VA or non-VA facility.

Main outcomes and measures: The 1-year all-cause mortality and 1-year readmission rates for myocardial infarction or coronary revascularization from date of discharge were compared between VA vs non-VA CR participants using Cox proportional hazards models with inverse probability treatment weighting.

Results: The 7320 veterans with ischemic heart disease who participated in CR programs had a mean (SD) age of 65.13 (8.17) years and were predominantly white (6005 patients [82.0%]), non-Hispanic (6642 patients [91.0%]), and male (7191 patients [98.2%]). Among these 7320 veterans, 2921 (39.9%) attended a VA facility, and 4399 (60.1%) attended a non-VA CR facility. Black and Hispanic veterans were more likely to attend CR programs at VA facilities (509 patients [17.4%] and 378 patients [12.9%], respectively), whereas white veterans were more likely to attend CR programs at non-VA facilities (3759 patients [85.5%]). After inverse probability treatment weighting, rates of 1-year mortality were 1.7% among VA CR participants vs 1.3% among non-VA CR participants (hazard ratio, 1.32; 95% CI, 0.90-1.94; P = .15). Rates of readmission for myocardial infarction or revascularization during the 12 months after discharge were 4.9% among VA CR participants vs 4.4% among non-VA CR participants (hazard ratio, 1.06; 95% CI, 0.83-1.35; P = .62).

Conclusions and relevance: These findings suggest that rates of 1-year mortality and 1-year readmission for myocardial infarction or revascularization did not differ for participants in VA vs non-VA cardiac rehabilitation programs. Eligible patients with ischemic heart disease should participate in CR programs regardless of where they are provided.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Schopfer reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Probabilities of 1-Year Survival and Readmission
A, One-year survival free of death among veterans attending cardiac rehabilitation (CR) at Veterans Affairs (VA) vs non-VA facilities from Cox proportional hazards model with inverse probability of treatment weighting. B, One-year probability of readmission for acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting in veterans attending CR at VA vs non-VA facilities from Cox proportional hazards model with inverse probability of treatment weighting. Two hundred sixteen patients were excluded for missing demographic data. HR indicates hazard ratio.
Figure 2.
Figure 2.. Probability of Mortality at 1 Year by Number of Cardiac Rehabilitation (CR) Sessions
Adjusted marginal probability of 1-year mortality (line) with 95% CIs (shaded areas), by number of CR sessions attended.
See this image and copyright information in PMC

References

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