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Cardiac Rehabilitation After MI Does Not Affect Health Status
Recent results of a restrospective cohort study show that patients who participated in a cardiac rehabilitation (CR) program during the year following hospital discharge for an acute myocardial infarction (AMI) had similar disease-specific and generic health status compared to patients who did not participate in a CR program.
However, the study did find that CR conferred a significant survival benefit.
“Our results underscore the need for further investigation of the effect of participation in CR on health status to identify if and how PR programs can better maximize health status outcomes for patients after AMI,” state the authors of the study.1
The American Heart Association and American College of Cardiology currently recommend referral to CR for patients following an AMI, endorsing it as a performance measure for quality of care of these patients.
Although data show that CR improves survival after AMI, the effect of CR on patients’ health status (such as quality of life, symptoms, and functional status) is not well defined.
To look at the health status outcomes after AMI associated with participation in CR, Faraz Kureshi, MD, Division of Cardiovascular Diseases and Cardiovascular Outcomes Research, Saint Luke’s Mid America Heart Institute, Kansas, City, MO, and colleagues retrospectively examined health status outcomes in a cohort of 4929 patients with AMI identified in two AMI registries across 31 US centers.
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Of the 4929 patients, 2015 had participated in at least 1 CR session within 6 months of hospital discharge and 2914 did not participate in CR.
Using the Seattle Angina Questionnaire (SAQ) and 12-item Short-Form Health Survey (SF-12) to quantify health status, the investigators assessed the difference in health status outcomes between patients who did and did not participate in CR based on the mean differences in SAQ domain scores during the year following AMI (primary outcome). The mean differences in the SF-12 summary scores and all-cause mortality were secondary outcomes of the study.
At 6- and 12-months following AMI, the study found that the mean differences in the SAQ domain scores were similar between the patients who participated in CR and those who did not. At 6- and 12- months, the mean difference was -0.76 (95% CI, -2.05 to 0.52) and -0.89 (95% CI, -2.20 to 0.43) for the SAQ quality of life score, respectively; -1.53 (95% CI, -2.57 to 0.49) and -1.05 (95% CI, -2.12 to 0.02), respectively, for the SAQ angina frequency score; 0.38 (95% CI, -0.51 to 1.27) and 0.38 (95% CI, -0.54 to 1.29), respectively, for the SAQ treatment satisfaction score; and -0.42 (95% CI, -1.65 to 0.79) and -0.14 (95% CI, -1.41 to 1.14), respectively, for the SAQ physical limitation score.
The study also found similar mean differences in the SF-12 domain scores between the two groups.
When looking at survival, however, patients who participated in CR had a significantly higher survival. The hazard rate of all-cause mortality up to 7 years was 0.59 (95% CI, 0.46 to 0.75) for patients participating in CR. —Mary Beth Nierengarten
Reference
1. Kureshi F, Kennedy KF, Jones PG, et al. Association between cardiac rehabilitation participation health status outcomes after acute myocardial infarction. JAMA Cardiol. Published online October 19, 2016. doi:10.1001/jamacardio.2016.3458.
