Cardiac rehabilitation after acute myocardial infarction does not improve health status outcomes

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A new study, published in JAMA Cardiology, indicates that health status outcomes in patients who undergo cardiac rehabilitation after an acute myocardial infarction are not significantly better than those of patients who do not undergo cardiac rehabilitation. However, similar to previous studies, the study found that cardiac rehabilitation significantly reduces mortality.

Writing in the journal, authors Faraz Kureshi (Saint Luke’s Mid America Heart Institute, Kansas City, USA) and others report that “systematic reviews and meta-analyses” have shown that cardiac rehabilitation after an acute myocardial infarction is associated with reduced mortality. However, they add that while health status improvement “is among the commonly cited goals and benefits of cardiac rehabilitation”, there is sparse evidence for this supposed benefit. Therefore, Kureshi et al used data from PREMIER (Prospective registry evaluating myocardial infarction: events and recovery) and TRIUMPH (Translational research investigating underlying disparities in acute myocardial infarction patients’ health status) to “compare patient-reported health status between those who did and did not participate in cardiac rehabilitation”.

Of a final analytic cohort of 4,929, 2,015 patients (40.9%) reported participating in cardiac rehabilitation within six months hospitalisation of an acute myocardial infarction. “Compared with those who did not participate in cardiac rehabilitation, a higher proportion of participants were male (70.8% vs. 65.2%), white (83.6% vs. 63%), married (68.3% vs. 52%), employed full time (45.8% vs. 35.1%), had health insurance coverage for medications (85.1% vs. 71.1%), and received coronary revascularisation during hospitalisation for acute myocardial infarction (86% vs. 70.1%),” Kureshi et al comment. They add that patients who participated in cardiac rehabilitation were less likely to avoid seeking healthcare for cost reasons and “were generally healthier”.

In a propensity-matched cohort, the mean Seattle angina questionnaire (SAQ) quality of life, angina frequency, treatment satisfaction, and physical limitation scores at six and 12 months were similar between patients (2,012) who underwent cardiac rehabilitation compared with those who did not (2,894). The SAQ angina frequency scores at six months were significantly higher among those who did not undergo cardiac rehabilitation but Kureshi et al note: “This difference was well below the generally accepted threshold of clinical importance (≥5 points)”. Furthermore, mean 12-item short-form health survey (SF-12) physical component summary and mental component summary scores at six and 12 months were also similar between groups. The authors comment: “Although improvement in health status is a commonly cited benefit of participation in cardiac rehabilitation after acute myocardial infarction, our results and prior work underscore the paucity of data to support this.”

However, according to the seven-year follow-up data of the propensity-matched cohort, patients who underwent cardiac rehabilitation had a 41% lower hazard rate of mortality compared with those who did not. Kureshi told Cardiovascular News: “Although an improved quality of life is among the commonly quoted benefits of participation in cardiac rehabilitation, in our study of nearly 5,000 patients enrolled in two acute myocardial infarction registries across multiple US centres, health status improved in all patients over the year following acute myocardial infarction with no significant differences noted between cardiac rehabilitation participants and non-participants. However, we did observe that cardiac rehabilitation participation conferred a significant long-term survival benefit.  Despite no difference in health status noted in our study, patients who have suffered an acute myocardial infarction should continue to be referred and strongly encouraged to participate in a comprehensive cardiac rehabilitation program, given its association with increased survival.”

Kureshi et al conclude: “Our results underscore the need for further investigation of the effect of participation in cardiac rehabilitation on health status to identify if and how cardiac rehabilitation programmes can better maximise health status outcomes for patients after acute myocardial infarction.”