Clinical research study
Participation in Cardiac Rehabilitation, Readmissions, and Death After Acute Myocardial Infarction

https://doi.org/10.1016/j.amjmed.2014.02.008Get rights and content

Abstract

Background

Participation in cardiac rehabilitation has been shown to decrease mortality after acute myocardial infarction, but its impact on readmissions requires examination.

Methods

We conducted a population-based surveillance study of residents discharged from the hospital after their first-ever myocardial infarction in Olmsted County, Minnesota, from January 1, 1987, to September 30, 2010. Patients were followed up through December 31, 2010. Participation in cardiac rehabilitation after myocardial infarction was determined using billing data. We used a landmark analysis approach (cardiac rehabilitation participant vs not determined by attendance in at least 1 session of cardiac rehabilitation at 90 days post-myocardial infarction discharge) to compare readmission and mortality risk between cardiac rehabilitation participants and nonparticipants accounting for propensity to participate using inverse probability treatment weighting.

Results

Of 2991 patients with incident myocardial infarction, 1569 (52.5%) participated in cardiac rehabilitation after hospital discharge. The cardiac rehabilitation participation rate did not change during the study period, but increased in the elderly and decreased in men and younger patients. After adjustment, cardiac rehabilitation participants had lower all-cause readmission (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.65-0.87; P < .001), cardiovascular readmission (HR, 0.80; 95% CI, 0.65-0.99; P = .037), noncardiovascular readmission (HR, 0.72; 95% CI, 0.61-0.85; P < .001), and mortality (HR, 0.58; 95% CI, 0.49-0.68; P < .001) risk.

Conclusions

Cardiac rehabilitation participation is associated with a markedly reduced risk of readmission and death after incident myocardial infarction. Improving cardiac rehabilitation participation rates may have a large impact on post-myocardial infarction healthcare resource use and outcomes.

Section snippets

Study Design and Setting

This study was conducted in Olmsted County, Minnesota. Population-based research is possible because there are few hospitals, namely, Olmsted Medical Center and Mayo Clinic. Medical records from all sources of care for residents are extensively indexed and linked via the Rochester Epidemiology Project.13 Therefore, patient-level information can be obtained via the medical and administrative records. This study was approved by the Mayo Clinic and Olmsted Medical Center Institutional Review

Patient Characteristics

A total of 2991 patients were diagnosed with incident myocardial infarction from January 1, 1987, to September 30, 2010, and survived to hospital discharge. The characteristics of the study population are shown in Table 1. Cardiac rehabilitation participants were more likely to be obese, to smoke, to have hyperlipidemia, to be cared for by a cardiologist in the hospital, to receive reperfusion/revascularization, to be treated with beta-blockers and aspirin, and to have ST-elevation myocardial

Discussion

Among this community cohort, only half of patients participated in cardiac rehabilitation after myocardial infarction. Although age and gender disparities existed in likelihood of participation, they narrowed over time. Participation in cardiac rehabilitation was associated with a lower post-myocardial infarction mortality and a reduced risk of cardiovascular and noncardiovascular readmissions.

Conclusions

Despite the clear benefits of participation in cardiac rehabilitation, it remains underused after acute myocardial infarction. In this community cohort, although only half of patients attended cardiac rehabilitation, participation was associated with marked reductions in hospital readmissions and mortality. Increasing participation in cardiac rehabilitation after myocardial infarction should be considered as part of a strategy to reduce readmissions.

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  • Cited by (0)

    Funding: This study was supported by grants from the National Institutes of Health (K23 HL116643 [SMD] and RO1-HL59205 [VLR]), and was made possible by the Rochester Epidemiology Project (R01-AR30582 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases).

    Conflict of Interest: None.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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