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Cardiac rehabilitation: referral, participation, and mortality following elective PCI

Session Time to go to rehab - Best of cardiac rehabilitation

Speaker Jacob Klein

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Moderated Posters

Authors : J Klein (Jerusalem,IL), R Farkash (Jerusalem,IL), N Raviv Abeles (Jerusalem,IL), A Karawan (Jerusalem,IL), A Kirschner (Jerusalem,IL), Z Mizrachi (Jerusalem,IL), R Aran (Jerusalem,IL), J Balkin (Jerusalem,IL), M Klutstein (Jerusalem,IL), D Tzivoni (Jerusalem,IL), G Weisz (Jerusalem,IL)

Authors:
J. Klein1 , R. Farkash1 , N. Raviv Abeles1 , A. Karawan1 , A. Kirschner1 , Z. Mizrachi1 , R. Aran1 , J. Balkin1 , M. Klutstein1 , D. Tzivoni1 , G. Weisz1 , 1Shaare Zedek Medical Center, Cardiology - Jerusalem - Israel ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1032

Background: Cardiac rehabilitation (CR) has been shown to be effective in wide range of cardiovascular conditions. However, there is scarce data regarding the prognostic benefits of CR in patients with stable CAD following elective PCI.

Methods: We retrospectively analyzed all patients who had elective PCI during 2007–2016. Patients who had PCI for ACS/AMI were excluded. We compared the characteristics and outcomes of the patients who participated in CR to those who did not participate. The CR program included supervised exercise training, lifestyle modification interventions, and risk factor control. Mortality data were extracted from national census.

Results: Total of 2683 patients had elective PCI. Of these 1670 (63%) were referred to CR but only 464 (17%) actually participated in the program. Predictors of CR participation included: DES use (OR=1.45 95% CI[1.09–1.92]) and radial access (OR=1.53 95% CI[1.18–1.98]); and lower rates of DM (OR=0.71 95% CI[0.55–0.92]), prior CABG (OR=0.56 95% CI[0.34–0.93]), chronic renal failure (OR=0.48 95% CI[0.27–0.86]), and smoking (OR=0.63 95% CI[0.48–0.83]). Median follow-up time was 3.3 [1.4–6.1] years. Survival curves are shown in the Figure. Independent predictors of mortality included age (HR=1.05 95% CI[1.03–1.08]), DM (HR=2.2 95% CI[1.36–3.46]), peripheral vascular disease (HR=2.27 95% CI[1.00–5.13]), prior stroke (HR=2.14 95% CI[1.00–4.57]), CHF (HR=4.26 95% CI[1.26–14.41]) and multi-vessel coronary disease (HR=2.86 95% CI[1.64–4.99]). Participation in CR was protective of mortality (HR 0.48, 95% CI 0.24–0.98, p=0.044).

Conclusions: Only 17% of patients that had elective PCI participated in a CR. Participation in CR program was associated with significant reduction in mortality. Referral and participation in CR programs should be vigorously encouraged to all patients after elective PCI.

K-M survival curves

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