title: The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003.
abstract: BACKGROUND
  International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI in two consecutive decades.
  
  
  RESULTS
  A total of 2196 and 2055 patients were recruited in the prospective observational studies of the Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) -1 and 2 in 1995 and 2003, (1995: median age 72 years, 39% women, 74% referred vs 2003: median age 71 years, 36% women, 64% referred) and followed up through September 2010. Survival functions showed CR referral to be an independent predictor for survival in 2003, but not in 1995 (hazard ratio (HR), 0.90; 95% confidence interval [CI]; 0.70 to 1.17, p = 0.44 in 1995 vs HR, 0.80; 95% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003.
  
  
  CONCLUSIONS
  CR referral was associated with improved survival in 2003, but not in 1995 in patients admitted with acute MI.
authors.affiliation: Department of Health Science, University of York, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Lewinter
authors.forename: John M
authors.initials: JM
authors.lastname: Bland
authors.forename: Simon
authors.initials: S
authors.lastname: Crouch
authors.forename: Patrick
authors.initials: P
authors.lastname: Doherty
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewin
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Alistair S
authors.initials: AS
authors.lastname: Hall
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Gale
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D009204:Myocardial Revascularization; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents