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Heart doi:10.1136/heartjnl-2012-303022
  • Cardiac rehabilitation
  • Original article

Attendance at cardiac rehabilitation is associated with lower all-cause mortality after 14 years of follow-up

  1. Alan Goble1
  1. 1Heart Research Centre, Melbourne, Australia
  2. 2School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
  3. 3Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
  4. 4Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  5. 5Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
  6. 6Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Alison Beauchamp, Heart Research Centre, Royal Melbourne Hospital, PO Box 2137, Post Office, Melbourne, VIC 3050, Australia;  alison.beauchamp{at}heartresearchcentre.org
  • Received 16 September 2012
  • Revised 31 October 2012
  • Accepted 6 November 2012
  • Published Online First 4 December 2012

Abstract

Objective To investigate whether attendance at cardiac rehabilitation (CR) independently predicts all-cause mortality over 14 years and whether there is a dose–response relationship between the proportion of CR sessions attended and long-term mortality.

Design Retrospective cohort study.

Setting CR programmes in Victoria, Australia

Patients The sample comprised 544 men and women eligible for CR following myocardial infarction, coronary artery bypass surgery or percutaneous interventions. Participants were tracked 4 months after hospital discharge to ascertain CR attendance status.

Main outcome measures All-cause mortality at 14 years ascertained through linkage to the Australian National Death Index.

Results In total, 281 (52%) men and women attended at least one CR session. There were few significant differences between non-attenders and attenders. After adjustment for age, sex, diagnosis, employment, diabetes and family history, the mortality risk for non-attenders was 58% greater than for attenders (HR=1.58, 95% CI 1.16 to 2.15). Participants who attended <25% of sessions had a mortality risk more than twice that of participants attending ≥75% of sessions (OR=2.57, 95% CI 1.04 to 6.38). This association was attenuated after adjusting for current smoking (OR=2.06, 95% CI 0.80 to 5.29).

Conclusions This study provides further evidence for the long-term benefits of CR in a contemporary, heterogeneous population. While a dose–response relationship may exist between the number of sessions attended and long-term mortality, this relationship does not occur independently of smoking differences. CR practitioners should encourage smokers to attend CR and provide support for smoking cessation.