title: Cardiac rehabilitation attendance and outcomes in coronary artery disease patients.
abstract: BACKGROUND
  Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients with coronary artery disease. The objective of this study was to determine the association between CR completion and mortality and resource use.
  
  
  RESULTS
  We conducted a prospective cohort study of 5886 subjects (20.8% female; mean age, 60.6 years) who had undergone angiography and were referred for CR in Calgary, AB, Canada, between 1996 and 2009. Outcomes of interest included freedom from emergency room visits, hospitalization, and survival in CR completers versus noncompleters, adjusted for clinical covariates, treatment strategy, and coronary anatomy. Hazard ratios for events for CR completers versus noncompleters were also constructed. A propensity model was used to match completers to noncompleters on baseline characteristics, and each outcome was compared between propensity-matched groups. Of the subjects referred for CR, 2900 (49.3%) completed the program, and an additional 554 subjects started but did not complete CR. CR completion was associated with a lower risk of death, with an adjusted hazard ratio of 0.59 (95% confidence interval, 0.49-0.70). CR completion was also associated with a decreased risk of all-cause hospitalization (adjusted hazard ratio, 0.77; 95% confidence interval, 0.71-0.84) and cardiac hospitalization (adjusted hazard ratio, 0.68; 95% confidence interval, 0.55-0.83) but not with emergency room visits. Propensity-matched analysis demonstrated a persistent association between CR completion and reduced mortality.
  
  
  CONCLUSIONS
  Among those coronary artery disease patients referred, CR completion is associated with improved survival and decreased hospitalization. There is a need to explore reasons for nonattendance and to test interventions to improve attendance after referral.
authors: Libin Cardiovascular Institute, Room C849, 8th Floor Cardiology, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada. bmartin@ucalgary.ca
authors: Billie-Jean
authors: BJ
authors: Martin
authors: Trina
authors: T
authors: Hauer
authors: Ross
authors: R
authors: Arena
authors: Leslie D
authors: LD
authors: Austford
authors: P Diane
authors: PD
authors: Galbraith
authors: Adriane M
authors: AM
authors: Lewin
authors: Merril L
authors: ML
authors: Knudtson
authors: William A
authors: WA
authors: Ghali
authors: James A
authors: JA
authors: Stone
authors: Sandeep G
authors: SG
authors: Aggarwal
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012017:Referral and Consultation / Q000639:trends; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome