Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study

• Published in: Archives of cardiovascular diseases 2016-03, Vol.109 (3), p.178-187
• Main Authors: Pouche, Marion, Ruidavets, Jean-Bernard, Ferrières, Jean, Iliou, Marie-Christine, Douard, Hervé, Lorgis, Luc, Carrié, Didier, Brunel, Philippe, Simon, Tabassome, Bataille, Vincent, Danchin, Nicolas
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - rehabilitation; Acute myocardial infarction; Aged; Cardiac rehabilitation; Cardiology and cardiovascular system; Cardiovascular; Chi-Square Distribution; Female; Follow-Up Studies; France; Human health and pathology; Humans; Infarctus du myocarde aigu; Infarctus du myocarde avec sus-décalage du segment ST; Infarctus du myocarde sans sus-décalage du segment ST; Internal Medicine; Kaplan-Meier Estimate; Life Sciences; Male; Middle Aged; Mortality; Mortalité; Multivariate Analysis; Myocardial Infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - rehabilitation; Non–ST-segment elevation myocardial infarction; Patient Discharge; Proportional Hazards Models; Prospective Studies; Referral and Consultation; Registries; Risk Assessment; Risk Factors; Réadaptation cardiaque; ST-segment elevation myocardial infarction; Time Factors; Treatment Outcome
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2015.09.009

Summary Background Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality. Objective To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI). Methods Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n = 1523) and non-STEMI (NSTEMI; n = 1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model. Results At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5 years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients ( P < 0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60–0.96). Analyses stratified by sex, age (< 60 vs. ≥ 60 years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48–0.87) than in women (HR 0.95, 95% CI 0.64–1.39), in younger (HR 0.34, 95% CI 0.15–0.77) than in older patients (HR 0.84, 95% CI 0.65–1.07) and in NSTEMI (HR 0.63, 95% CI 0.46–0.88) than in STEMI (HR 0.99, 95% CI 0.69–1.40). Conclusion After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.