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. 2021 Dec 29;28(15):1704-1710.
doi: 10.1093/eurjpc/zwab035.

Cardiac rehabilitation and all-cause mortality in patients with heart failure: a retrospective cohort study

Benjamin J R Buckley  1 , Stephanie L Harrison  1 , Elnara Fazio-Eynullayeva  2 , Paula Underhill  3 , Rajiv Sankaranarayanan  4 , David J Wright  1 , Dick H J Thijssen  5   6 , Gregory Y H Lip  1   7
Affiliations

Cardiac rehabilitation and all-cause mortality in patients with heart failure: a retrospective cohort study

Benjamin J R Buckley et al. Eur J Prev Cardiol. .

Abstract

Aims: Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF). The aim of this study was therefore to investigate the association of exercise-based CR with all-cause mortality, hospitalisation, stroke, and atrial fibrillation in patients with heart failure.

Methods and results: A retrospective cohort study was conducted which utilized a global federated health research network, primarily in the USA. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of CR and/or exercise programmes within 6 months of an HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, comorbidities, medications, and procedures (controls). We ascertained 2-year incidence of all-cause mortality, hospitalization, stroke, and atrial fibrillation. Following propensity score matching, a total of 40 364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality [odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62], 26% lower odds of hospitalization (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to controls, after propensity score matching. The beneficial association of CR and exercise on all-cause mortality was consistent across all subgroups, including patients with HFrEF (0.52, 95% CI 0.48-0.56) and HFpEF (0.65, 95% CI 0.60-0.71).

Conclusion: Exercise-based CR was associated with lower odds of all-cause mortality, hospitalizations, incident stroke, and incident atrial fibrillation at 2-year follow-up for patients with HF (including patients with HFrEF and HFpEF).

Keywords: Cardiac rehabilitation; Exercise; Heart failure; Retrospective cohort; Secondary prevention.

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