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The importance of a successful cardiac rehabilitation program - long-term prognosis of cardiac patients following rehabilitation

Session Young Investigator Award 3 - Secondary prevention and rehabilitation Section

Speaker Mr Nicolai Mikkelsen

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Cardiovascular Rehabilitation
  • Session type : Young Investigator Award Abstracts

Authors : N Mikkelsen (Copenhagen,DK), C Cadarso-Suarez (Santiago de Compostela,ES), O Lado-Baleato (Santiago de Compostela,ES), C Diaz-Louzao (Santiago de Compostela,ES), J Reeh (Copenhagen,DK), H Rasmusen (Copenhagen,DK), E Prescott (Copenhagen,DK)

N Mikkelsen1 , C Cadarso-Suarez2 , O Lado-Baleato2 , C Diaz-Louzao2 , J Reeh1 , H Rasmusen1 , E Prescott1 , 1Bispebjerg University Hospital, Department of Cardiology - Copenhagen - Denmark , 2University of Santiago de Compostela, Unit of Biostatistics, Department of Statistics - Santiago de Compostela - Spain ,

Cardiovascular Rehabilitation


It is well documented that participants in CR have a better long-term prognosis than non-participants. However, differences in long-term prognosis might also be present within the patients that complete CR. We investigated whether change in VO2peak following CR was a predictor for long-term prognosis in terms of future cardiovascular events and all-cause mortality.


This was a retrospective study on cardiac patients who completed a CR program at a CR unit in Copenhagen from 2011-2017. Effect of CR was defined as change in VO2peak (assessed before and after CR) and outcomes were defined as subsequently suffering a new cardiovascular event (recurrent MI, unstable angina, heart failure or stroke) and/or death. We used a multi-state model with three transitions to predict new cardiovascular events and all-cause mortality (see figure 1). All patients were at risk of having a new cardiovascular event (transition 1). If suffering a new cardiovascular event, they were subsequently at risk of dying (transition 2). The patients that did not suffer a new cardiovascular event were similarly at risk of dying (transition 3).


1237 patients completed CR and had full data on VO2peak and explanatory variables. Mean follow-up time was 2.5 years. Approximately 30 percent of the patients did not improve in VO2peak following rehabilitation.

156 patients suffered a cardiovascular event (transition 1). Improvement in VO2peak associated with a decreased risk of a future cardiovascular event, even after adjustment for age, gender, index diagnoses, comorbidities and baseline VO2peak, see figure 2. 25 patients died after suffering a new cardiovascular event (transition 2) and this was not associated change in VO2peak. 50 patients died without suffering a new event (transition 3) and this risk was highly associated with change in VO2peak with a linear decrease of 21.12 % of risk of death for each unit of VO2peak improvement, also after full adjustment.


Change in VO2peak after CR is a highly relevant parameter in prediction of future cardiovascular events and of all-cause mortality.

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