The Impact of Cardiac Rehabilitation on Mental Health, Cardiac-Related Quality of Life and Mortality Following Coronary Artery Bypass Grafting (CABG) Surgery: A 12-Year Multicentre Study - The 64th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 25-26 April 2017

Galit Geulayov ¹ Yaacov Drory ² Ilya Novikov ³ Arnona Ziv ⁴ Uri Goldbourt ² Ehud Schwamenthal ² Rachel Dankner ^1,2

¹Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre
²School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University
³Unit for Biostatistics, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre
⁴Information and Computerization Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre

Aims:
To investigate the overall and the age-specific impact of participation in cardiac rehabilitation (CR) after coronary artery bypass grafting (CABG) surgery on 1-year and 12-year outcomes.

Methods:
Mental health and cardiac-related quality of life (QoL) were measured before and 1-year after surgery with the Hospital Anxiety and Depression Scale (HADS) and the MACNEW scale, respectively. CR participation was ascertained through a personal interview and all-cause mortality through the Israeli Ministry of Internal Affairs Register (through May 2015). During 2004-2009, 1,122 patients from seven medical centres across Israel completed the baseline assessment, 840 of whom had information on CR participation and outcomes. Multivariable regression models quantified the impact of CR participation on outcomes using propensity score to account for the non-randomized allocation to CR.

Results:
CR participation following CABG surgery was associated with lower depression and anxiety scores at 1-year follow-up relative to non-attendance, adjusting for propensity score and for mental health at baseline [β=-0.8, 95% confidence interval (CI) -1.2 to -0.3; β= -0.8, 95% CI -1.4 to -0.1, respectively]; it was also associated with higher QoL scores including physical (β=0.3, 95% CI 0.1-0.4), emotional (β=0.2, 95% CI 0.02-0.4), and social (β=0.3, 95% CI 0.2-0.5) functioning. There were no CR status by age group (under 65 versus ≥65 years) interactions (p=0.38-0.95). CR participation was associated with lower mortality in the older cardiac patients, aged 65 years and over, [adjusted hazard ratio (AHR) 0.58, 95% CI 0.34-0.98] but not in the younger patients.

Conclusions:
CR participation was associated with improved mental health and cardiac-related QoL 1-year after CABG surgery but long-term survival was improved in the older patients and not in the younger ones. This work highlights the need to improve uptake of CR, especially in older individuals - a group under-represented in rehabilitation programs.