The Utility and Outcome of Multidisciplinary Cardiac Rehabilitation After Myocardial Infarction in The Modern Era

Background: Cardiac Rehabilitation (CR) has been shown to be effective in reducing mortality in the era preceding modern treatment of myocardial infarction (MI), but its benefit was questioned following modern early revascularization. We sought to examine the characteristics and outcomes of MI patients who were eligible and referred for CR.

Methods: Patients with acute MI were referred to an outpatient cardiac Multidisciplinary rehab program. The program included personalized and supervised adjusted physical activity twice weekly for at least 3 months, lifestyle modification interventions, and risk factor control including recommendation for medication adjustment. Patients that could not participate due to orthopedic or cognitive impairments were excluded. We compared the patients who participated in the program to those who elected not to participate in the years 2007-2014. Mortality data was extracted from the government civil registry.

Results: Of 4049 eligible patients who were referred to CR, 2079 (51.3%) participated in the program, and 1970 (48.7%) elected not to participate. Independent predictors to participate in the CR program included STEMI, age <75, male gender, non-DM, non-smoker, no prior CABG, and no PVD.

CR as compared to non-CR patients had lower rates of 1-year hospital readmission (11.9% vs. 22.0%, p<0.001), and mortality (0.5% vs. 1.7%, p=0.027). Multivariate analysis revealed that CR was an independent predictor protecting from mortality (OR 0.53, 95%CI 0.44-0.65, p<0.001). Other predictors of mortality included prior CABG (OR 1.53), DM (OR 1.36), and hypertension (OR1.31), all p<0.01.

Conclusions: Following acute MI, only half of the patients who were referred and eligible for CR elected to participate. Patients who participated in CR program had a significantly lower readmission rates and lower mortality. Participation in CR rehabilitation program should be vigorously encouraged to all patients after MI.