Effect of Initiating Cardiac Rehabilitation After Myocardial Infarction on Subsequent Hospitalization in Older Adults. Issue 2 (March 2020)

• Record Type: Journal Article
• Authors: Bush, Montika; Kucharska-Newton, Anna; Simpson, Ross J.; Fang, Gang; Stürmer, Til; Brookhart, M. Alan
• Is Part Of: Journal of cardiopulmonary rehabilitation and prevention. Volume 40:Issue 2(2020)
• Publication Date: 2020-03
• Subjects: cardiac rehabilitation -- competing risk analysis -- Medicare; Cardiopulmonary system -- Diseases -- Patients -- Rehabilitation -- Periodicals; Cardiopulmonary system -- Diseases -- Prevention -- Periodicals; 616.103
• DOI: 10.1097/HCR.0000000000000452
• Languages: English
• ISSNs: 1932-7501

Abstract

Abstract : Purpose: Outpatient cardiac rehabilitation (CR) participation after myocardial infarction (MI) reduces all-cause mortality; however, less is known about effects of CR on post-MI hospitalization. The study objective was to investigate effects of CR on hospitalization following acute MI among older adults. Methods: Medicare beneficiaries aged 65 to 88 yr hospitalized in 2008 with acute MI, who survived at least 60 d post-discharge, had a revascularization procedure during index hospitalization, and did not have an MI in previous year were eligible for this study. CR initiation was assessed in the 60 d post-discharge. Competing risk survival analysis was used to estimate the proportion of discharged beneficiaries hospitalized between the end of 60-d exposure window and December 31, 2009, treating death as a competing event. Results: The mean ± SD age of 32 851 Medicare beneficiaries meeting study criteria was 75 ± 6.0 yr, approximately half were male (52%), and the majority were white (88%). In this study, 21% of beneficiaries initiated CR within the exposure window. At 1 yr post-discharge, CR initiators had a lower risk of recurrent MI (4.2% [95% CI, 3.5-5.1]), cardiovascular (15.7% [95% CI, 14.3-17.2]), and all-cause (30.4% [95% CI, 28.8-32.1]) hospitalization than noninitiators (5.2% [95% CI, 5.0-5.5]; 18.0% [95% CI, 17.6-18.4]; and 33.2% [95% CI, 32.5-33.8], respectively). There was no difference in fracture risk (negative control outcome). Conclusions: This study provides evidence that CR can reduce the 1-yr risk of cardiovascular and all-cause hospital admissions in Medicare aged MI survivors. Abstract : Supplemental Digital Content is Available in the Text.The effect of cardiac rehabilitation (CR) was investigated in a population of Medicare benefi ciaries surviving an acute myocardial infarction (MI). At 1 yr post discharge, CR initiators had a lower risk of cardiovascular hospitalization than non-initiators accounting for the competing risk of death. CR participation should be encouraged even among older adult MI survivors.