Referral, Utility and Outcome of Multidisciplinary Cardiac Rehabilitation after Elective PCI

Background:
Cardiac Rehabilitation (CR) has been shown to be effective, in improving risk factors, QOL, and prognosis in patients after wide range of cardiovascular events . However there is scarce knowledge regarding the prognostic benefits of CR participation of patients with stable CAD post elective PCI.

Methods:
We reviewed the charts of all patients who had elective PCI during 2007-2016 and compared the patients who participated in CR to those who did not participate. The multidisciplinary CR program included supervised exercise training, lifestyle modification interventions, and risk factor control. Patients who had urgent PCI for ACS/AMI were excluded. Mortality data were extracted from national census.

Results:
Total of 2683 patients had elective PCI. Of these 1670 (63%) were referred to CR, but only 464 (28%) actually participated in the program. CR participation was associated with lower rates of DM (OR=0.71 95%CI[0.55-0.92]), prior CABG (OR=0.56 95%CI[0.34-0.93]), chronic renal failure (OR=0.48 95%CI[0.27-0.86]), smoking (OR=0.63 95%CI[0.48-0.83]) and with higher use rates of DES (OR=1.45 95%CI[1.09-1.92]) and radial access (OR=1.53 95%CI[1.18-1.98]). Survival curves are shown in the figure. Multivariate Cox analysis revealed that CR participation is an independent protective factor of mortality (HR 0.48, 95%CI 0.24-0.98, p=0.044). Other predictors of mortality included age (HR=1.05 95%CI[1.03-1.08]) , DM (HR=2.2 95%CI[1.36-3.46]), peripheral vascular disease (HR=2.27 95%CI[1.00-5.13]), prior stroke (HR=2.14 95%CI[1.00-4.57]), CHF (HR=4.26 95%CI[1.26-14.41]), multi-vessel coronary disease (HR=2.86 95%CI[1.64-4.99]). Radial access was also protective (HR=0.50 95%CI [0.30-0.84]).

Conclusions:
Only a quarter of patients that had elective PCI and were referred to CR actually participated in a CR program. Participation in the CR program was associated with significant reduction in mortality. Referral and participation in CR programs should be vigorously encouraged to all patients after PCI.