Cardiac Rehab After Acute MI Linked to Improved Survival, Medication Adherence

In older patients who have had an acute MI, cardiac rehabilitation is strongly associated with improved survival and fewer readmissions, according to a registry study published online August 7, 2015, ahead of print in the American Heart Journal. Attending more rehab sessions also boosts medication adherence.

Jacob A. Doll, MD, of the Duke Clinical Research Institute (Durham, NC), and colleagues looked at 36,376 patients 65 years or older who were enrolled between 2007 and 2010 in the National Cardiovascular Data Registry ACTION Registry-Get With The Guidelines database and were referred for cardiac rehabilitation.

Overall, 32.6% of patients participated in at least 1 rehabilitation session. The median number of sessions attended was 26, with higher participation more likely among men, STEMI patients, and those with fewer comorbidities and less prior revascularization.

Analysis of a subset of 8,391 patients with Medicare Part D prescription coverage—37% of whom participated in cardiac rehabilitation—showed that at 1 year, two-thirds of patients remained adherent to evidence-based secondary prevention medications. Those who attended 26 or more sessions were more likely to have kept taking P2Y12 inhibitors and beta-blockers than patients who attended fewer sessions. No difference based on rehab attendance was seen for adherence to statins or ACE inhibitors/angiotensin receptor blockers (table 1).

In addition, the degree of participation in rehabilitation correlated with improvement in outcomes. For every 5 additional sessions a patient attended beyond an initial session, the risks of mortality, MACE (death, readmission for MI, stroke, or revascularization), and a composite of death or readmission were reduced at 1 year (table 2).

Randal J. Thomas, MD, of the Mayo Clinic (Rochester, MN), told TCTMD in an email that the observational study adds to the growing evidence base showing the importance of cardiac rehabilitation.

“Patients who participate in cardiac rehabilitation after a cardiac event are more likely to live longer, feel better, and stay out of the hospital than patients who don’t participate,” Dr. Thomas said.

Catalyst for More Use of Rehab

According to a companion study by Dr. Doll and colleagues, only about one-third of eligible older patients choose to participate in cardiac rehabilitation, and only approximately one-quarter of those complete all 36 recommended sessions. Data from the current study “will be an additional piece of evidence to push for higher utilization rates and higher program attendance for patients who have had a recent cardiac event,” Dr. Thomas said.

Dr. Doll agreed in an email with TCTMD, adding that even in the contemporary era of acute MI treatment and even among the oldest patients, cardiac rehabilitation plays an important role in the recovery process.

“We know from prior studies that exercise is very important after MI, and that could be the dominant driver of improved outcomes,” he said. “However, our study also found that patients who attend more sessions are more likely to be adherent to their secondary prevention medications. This indicates that encouraging healthy lifestyles and medication adherence may also be important in improving outcomes.”

Source: 
Doll JA, Hellkamp A, Thomas L, et al. Effectiveness of cardiac rehabilitation among older patients after acute myocardial infarction. Am Heart J.  2015;Epub ahead of print.

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