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Observational Study
. 2021 Jun 15;10(12):e020804.
doi: 10.1161/JAHA.121.020804. Epub 2021 Jun 5.

Exercise-Based Cardiac Rehabilitation and All-Cause Mortality Among Patients With Atrial Fibrillation

Benjamin J R Buckley  1   2 , Stephanie L Harrison  1   2 , Elnara Fazio-Eynullayeva  3 , Paula Underhill  4 , Deirdre A Lane  1   2   5 , Dick H J Thijssen  6   7 , Gregory Y H Lip  1   2   5
Affiliations
Observational Study

Exercise-Based Cardiac Rehabilitation and All-Cause Mortality Among Patients With Atrial Fibrillation

Benjamin J R Buckley et al. J Am Heart Assoc. .

Abstract

Background There is limited evidence of long-term impact of exercise-based cardiac rehabilitation (CR) on clinical end points for patients with atrial fibrillation (AF). We therefore compared 18-month all-cause mortality, hospitalization, stroke, and heart failure in patients with AF and an electronic medical record of exercise-based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on February 3, 2021 from a global federated health research network. Patients with AF undergoing exercise-based CR were propensity-score matched to patients with AF without exercise-based CR by age, sex, race, comorbidities, cardiovascular procedures, and cardiovascular medication. We ascertained 18-month incidence of all-cause mortality, hospitalization, stroke, and heart failure. Of 1 366 422 patients with AF, 11 947 patients had an electronic medical record of exercise-based CR within 6-months of incident AF who were propensity-score matched with 11 947 patients with AF without CR. Exercise-based CR was associated with 68% lower odds of all-cause mortality (odds ratio, 0.32; 95% CI, 0.29-0.35), 44% lower odds of rehospitalization (0.56; 95% CI, 0.53-0.59), and 16% lower odds of incident stroke (0.84; 95% CI, 0.72-0.99) compared with propensity-score matched controls. No significant associations were shown for incident heart failure (0.93; 95% CI, 0.84-1.04). The beneficial association of exercise-based CR on all-cause mortality was independent of sex, older age, comorbidities, and AF subtype. Conclusions Exercise-based CR among patients with incident AF was associated with lower odds of all-cause mortality, rehospitalization, and incident stroke at 18-month follow-up, supporting the provision of exercise-based CR for patients with AF.

Keywords: arrhythmia; cardiovascular disease; cohort study; multimorbidity; preventive cardiology.

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Conflict of interest statement

Buckley has received funding from Bristol‐Myers Squibb (BMS)/Pfizer. Harrison has received funding from BMS. Fazio‐Eynullayeva and Underhill are employees of TriNetX LLC. Lane has received investigator‐initiated educational grants from BMS, has been a speaker for Boehringer Ingeheim, and BMS/Pfizer and has consulted for BMS, Boehringer Ingelheim, and Daiichi‐Sankyo. Lip has been a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi‐Sankyo and speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi‐Sankyo. No fees are directly received personally.

Figures

Figure. 1
Figure. 1. Subgroup‐specific odds ratios for all‐cause mortality at 18‐month follow‐up from incident atrial fibrillation diagnosis; comparing patients with atrial fibrillation who received exercise‐based cardiac rehabilitation with matched patients with atrial fibrillation who received usual care only (controls).
Sample size is number of patients in analysis with and without post‐incident atrial fibrillation diagnosis cardiac rehabilitation, following propensity‐score matching. AF indicates atrial fibrillation; AMI, acute myocardial infarction; BMI, body mass index; and CR, cardiac rehabilitation and exercise programs.
See this image and copyright information in PMC

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