Cardiac rehabilitation and all-cause mortality in patients with heart failure: A retrospective cohort study



Buckley, Ben ORCID: 0000-0002-1479-8872, Harrison, Stephanie ORCID: 0000-0002-8846-0946, Fazio-Eynullayeva, Elnara, Underhill, Paula, Sankaranarayanan, Rajiv ORCID: 0000-0003-2355-2011, Wright, David, Thijssen, Dick and Lip, Greg
(2021) Cardiac rehabilitation and all-cause mortality in patients with heart failure: A retrospective cohort study. European Journal of Preventive Cardiology, 28 (15). pp. 1704-1710.

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Abstract

<h4>Aims</h4>Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF). The aim of this study was therefore to investigate the association of exercise-based CR with all-cause mortality, hospitalisation, stroke, and atrial fibrillation in patients with heart failure.<h4>Methods and results</h4>A retrospective cohort study was conducted which utilized a global federated health research network, primarily in the USA. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of CR and/or exercise programmes within 6 months of an HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, comorbidities, medications, and procedures (controls). We ascertained 2-year incidence of all-cause mortality, hospitalization, stroke, and atrial fibrillation. Following propensity score matching, a total of 40 364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality [odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62], 26% lower odds of hospitalization (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to controls, after propensity score matching. The beneficial association of CR and exercise on all-cause mortality was consistent across all subgroups, including patients with HFrEF (0.52, 95% CI 0.48-0.56) and HFpEF (0.65, 95% CI 0.60-0.71).<h4>Conclusion</h4>Exercise-based CR was associated with lower odds of all-cause mortality, hospitalizations, incident stroke, and incident atrial fibrillation at 2-year follow-up for patients with HF (including patients with HFrEF and HFpEF).

Item Type: Article
Uncontrolled Keywords: Cardiac rehabilitation, Heart failure, Exercise, Secondary prevention, Retrospective cohort
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 19 Apr 2021 09:34
Last Modified: 18 Jan 2023 22:53
DOI: 10.1093/eurjpc/zwab061.328
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3119339