Predicting Long-Term Mortality, Morbidity, and Survival Outcomes Following a Cardiac Event: A Cardiac Rehabilitation Study

Abstract

The consequences of coronary heart disease (CAD) are many with premature death a potential reality. 1 Outpatient phase II cardiac rehabilitation (CR) is a non-invasive health care intervention that assists in the management of modifiable CAD risk factors. In the United States, Centers for Medicare and Medicaid Services (CMS) and third-party payers reimburse for CR. Historically, patients were enrolled within 3 months following hospital discharge 2 whereas today patients are enrolled earlier. Participants in CR demonstrate significant physical and psychosocial benefits. 3-6 Although a referral to CR is a Class 1A recommendation following an acute cardiac event programs are underutilized. 7,8 Mortality and morbidity are two outcomes studied to determine the effectiveness of CR services. Considered a secondary health prevention intervention, 9 CR is associated with reductions in mortality and morbidity. 3,10,11 In two seminal works published three decades ago, a 20% to 25% reduction in mortality was observed. 12,13 O'Connor and colleagues 12 in 1989 analyzed 22 randomized controlled trials (RCTs) of myocar-dial infarction (MI) patients and found CR effective in reducing all-cause mortality and cardiovascular (CV)-related mortality (odds ratio, OR = 0.80 and OR = 0.78, respectively). Subsequent studies including a number of reviews continue to support CR as an effective and efficient health care intervention. 10,11,14 In a 2012 overview of 6-independent CR meta-analyses including 13,824 patients, Oldridge 15 identified reductions in mortality and hospitalizations outcomes similar to results from their 1988 review. 13 The results for reduced ABSTRACT BACkgROund: Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity but estimations vary. While there is significant literature supporting short-term benefits, there is not a similarly body of research as to long-term (LT) benefits. Low participation rates in CR are due to several causes and evidence demonstrating positive LT outcomes could be a catalyst to increased participation rates.