Background: Cardiovascular diseases are among the leading burdens of disease globally, and are the leading cause of death, with >80% of these deaths occurring in low and middle-income countries, such as Brazil. Despite the epidemic of cardiovascular diseases in middle-income countries (MICs), there are few trials testing the benefits of cardiac rehabilitation (CR).Reduced mortality and morbidity in the long-term are likely achieved through maintenance of heart-health behavior changes initiated through CR, which ensures sustained risk factor control. Purpose:This trial assessed: (1) maintenance of functional capacity, risk factor control, knowledge and heart-health behaviors, as well as (2) mortality and morbidity 6 months following CR in a MIC. Methods:Eligible Brazilian coronary patients were initially randomized (1:1:1 concealed) to one of three parallel arms (comprehensive CR [exercise + education] vsexercise-only CR vswait-list control). The CR programs were six months in duration, at which point follow-up assessment was performed. Mortality and morbidity were ascertained from chart and patient/family-report (blinded). Controls were then offered CR. Outcomes were again assessed 6 months later (blinded). Analysis of covariance (ANCOVA) was performed for each outcome at 12 months.Results: 115 (88.5%) patients were randomized; 62 (53.9%) were retained at 1 year. At 6 months, of those 39 initially randomized to the wait-list control, 23 (58.9%) elected to attend CR. Functional capacity, risk factors, knowledge and heart-health behaviorswere maintained from 6-12 months in participants from both CR arms (all p>.05). At 1 year, there was significantly greater knowledge with CCR at either time point (p<.001). There were only two deaths. There were significantly fewer hospitalizations (p=.03), non-fatal myocardial infarctions (p=.04), and percutaneous coronary interventions (p=.03) with CR than control at 6-months.
Conclusions: CR participation is associated with lower morbidity, long-term maintenance of functional capacity, risk factors and heart-health behaviours as well as greater CV knowledge when compared to no CR.
Trial registration: Clinical Trials, NCT02575976. Registered 14 October 2015 (https://clinicaltrials.gov/show/NCT02575976).