56Impact of cardiac rehabilitation referral at hospital discharge on 1 year outcome of patients with acute myocardial infarction

Abstract

Background: Cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) has a class I recommendation in the present guidelines. However, data about the impact on mortality in Switzerland are not available. Therefore, we analysed 1-year outcome of AMI patients according to CR referral at discharge. Method(s): Data were extracted from the Swiss AMIS Plus registry and included patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) enrolled from 2005 to 2016 who were asked to give their informed consent to a telephone follow-up 1 year after discharge. We compared AMI patients with CR referrals at discharge to those without. Patients transferred to other hospitals were excluded. The analyses were performed using multivariable logistic regression. Result(s): From 10,141 patients, 1956 (19.3%) refused to participate in follow-up (FU) and of the 8,185 patients with informed consent, 302 were lost to FU. There were 4508 (57.2%) patients with CR referrals compared to 3375 (42.8%) without. Patients referred to CR were younger (62.4 y vs. 68.8 y), more often male (77 vs 70%), presented more often with STEMI (63.5 vs 52.1%) and apart from smoking (44.0 vs 34.9%), they had less risk factors, such as dyslipidemia (55.0 vs. 60.1%), hypertension (55.6 vs. 65.3%) and diabetes (16.7 vs. 21.5%). Patients without CR referrals were less likely to receive guideline-recommended medication, such as P2Y12 inhibitors, aspirin and statins and underwent less frequently percutaneous coronary intervention (PCI). Patients referred to CR had a lower crude 1-year allcause mortality (1.7 vs. 5.8%; p<0.001) and lower rates of re-infarction (2.8 vs. 4.1%; p=0.003), rehospitalisations for cardiovascular disease (21.0 vs. 25.3%; p<0.001) and interventions (11.7 vs. 14.8%; p<0.001). In a multivariable logistic regression analysis, which included age, gender, comorbidities, STEMI, PCI and discharge medication, CR was an independent protective predictor for mortality (OR 0.65; 95% CI 0.48-0.89; p=0.007). Conclusion(s): Although the detailed data of CR programs and patient participation were not available for this study, our data from 7883 AMI patients showed a better 1-year outcome for patients with CR referrals than for those without.