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The importance of a successful cardiac rehabilitation program - long-term prognosis of cardiac patients following rehabilitation
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
,
Citation:
Introduction
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.
Methods
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).
Results
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.
Conclusion
Change in VO2peak after CR is a highly relevant parameter in prediction of future cardiovascular events and of all-cause mortality.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
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