PARTICIPATION IN A COMPREHENSIVE CARDIAC REHABILITATION PROGRAM IMPROVES MID- AND LONG-TERM PROGNOSIS IN SURVIVORS OF ACUTE CORONARY SYNDROME

Abstract

Therapeutic Area

CVD Prevention – Primary and Secondary

Background

Cardiovascular disease is the leading cause of death in developed nations. While survival rates of myocardial infarction have improved in the last decades due to cost-intensive technical and organizational advances, efforts to improve prognosis through secondary prevention measures are often neglected. This study evaluates the effects of participation in a comprehensive cardiac rehabilitation program (CCR) on survival in patients presenting with acute coronary syndrome (ACS).

Methods

In Hungary, as of January 2014, by mandate data pertaining to patients suffering from ACS are entered into the National Myocardial Infarction Register (the Register), which by now stores data on 155,000 ACS events of more than 130,000 patients. Retrospective analysis was performed on the data of the Register.

Results

We examined data on 76,153 ACS cases that occurred from 2014 to 2019. For the purposes of this study, we focused on early survivors, and 66905 patients were included in our analysis (alive after 30 days of the index event). The main potentially modifiable protective factors, analyzed by binary regression model, were percutaneous coronary intervention (PCI), direct admission to a PCI capable hospital and participation in a comprehensive cardiac rehabilitation program. In Hungary, such programs include supervised physical exercise as well as patient education on smoking cessation, dietary changes, and medication compliance Our study showed that participation in CCR programs was associated with a 42% reduction in 1-year mortality for patients with ST-elevation myocardial infarction (STEMI) and improved long-term survival rates across various patient subgroups. Despite its efficacy, the participation rate in CCR was low, with only 21% of eligible patients completing such programs. The lowest rate of CCR participation was in non-ST-elevation myocardiac infarction (NSTEMI) patients that did not undergo PCI, a group that also exhibited the highest mortality rates. Factors predicting lower participation rates were older age, male gender, NSTEMI presentation, and lack of percutaneous coronary intervention (PCI).

Conclusions

This study shows a significant survival benefit of participation in a comprehensive cardiac rehabilitation program in early survivors of ACS. This finding was contrasted by a very low participation rate in this highly effective and cost-effective intervention. Increasing awareness of CCR’s benefits both amongst patients and providers, as well as increasing access to and availability of CCR should significantly improve survival rates following ACS.