The Role and Outcome of Cardiac Rehabilitation Program in Patients with Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is associated with increased morbidity and mortality, and impaired quality of life. We sought to investigate the role of cardiac rehabilitation program (CR) in patients with AF.

Methods: The study included 2165 consecutive patients that participated in our CR program between the years 2009 – 2015. All were evaluated by a standard exercise stress test at baseline, and upon completion of at least 3 months of training. The combined primary end point was cardiac hospitalization or cardiovascular-mortality.

Results: A total of 292 with AF, with a mean age of 68±9 years old 76% of which were males. Both groups showed improvement in their fitness level adjusted for the age and gender predicted METs. The mean improvements in fitness was more prominent in patients with AF (29% vs. 22%, p <0.001). In multivariate analysis, female, non-DM, low maximal pulse effort and preserved LVEF (>30%) were all significant independent predictors of increased improvement in exercise capacity after CR among AF patients. Kaplan-Mayer analysis shows that the highest cumulative rates of freedom from primary endpoint were observed in patients with high baseline fitness and a major improvement.

High baseline fitness was associated with the lowest event rate (HR 0.40; 95%CI 0.23-0.70; p=0.001).

Conclusion: In patients with AF participating in CR program low fitness levels at baseline EST are associated with increased risk of CVD mortality or hospitalization during long-term follow-up. Improvement on follow-up EST diminishes the risk, however, the protective effect is not as strong as the baseline fitness.