Article

Utilization of cardiac rehabilitation is suboptimal. The aim of the
study was to assess referral trends over the past decade, to identify predictors
for referral to a cardiac rehabilitation program, and to evaluate the association
with one-year mortality in a large national registry of acute coronary syndrome
patients. methods: Data were extracted from the Acute Coronary Syndrome
Israeli Survey national surveys between 2006-2013.
A total of 6551 patients
discharged with a diagnosis of acute coronary syndrome were included. Results:
Referral to cardiac rehabilitation following an acute coronary syndrome increased
from 38% in 2006 to 57% in 2013 ( p for trend < 0.001). Multivariate modeling
identified the following independent predictors for non-referral: 2006 survey,
older age, female sex, past stroke, heart or renal failure, prior myocardial
infarction, minority group, and lack of in-hospital cardiac rehabilitation center
(all p < 0.01). Kaplan-Meier survival analyses showed one-year survival rates of
97% vs 92% in patients referred for cardiac rehabilitation as compared to those
not referred (log-rank p < 0.01). Multivariate analysis showed that referral for
cardiac rehabilitation was associated with a 27% mortality risk reduction at
one-year follow-up ( p = 0.03). Consistently, a 32% lower one-year mortality risk
was evident in a propensity score matched group of 3340 patients (95% confidence
interval 0.48-0.95, p = 0.02). Conclusions Over the past decade there was a
significant increase in cardiac rehabilitation referral following an acute
coronary syndrome. However, cardiac rehabilitation is still under-utilized in
important high-risk subsets of this population. Patients referred to cardiac
rehabilitation have a lower adjusted mortality risk.

Langue : ANGLAIS