title: Attendance at cardiac rehabilitation is associated with lower all-cause mortality after 14 years of follow-up.
abstract: OBJECTIVE
  To investigate whether attendance at cardiac rehabilitation (CR) independently predicts all-cause mortality over 14 years and whether there is a dose-response relationship between the proportion of CR sessions attended and long-term mortality.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  CR programmes in Victoria, Australia
  
  
  METHODS
  The sample comprised 544 men and women eligible for CR following myocardial infarction, coronary artery bypass surgery or percutaneous interventions. Participants were tracked 4 months after hospital discharge to ascertain CR attendance status.
  
  
  METHODS
  All-cause mortality at 14 years ascertained through linkage to the Australian National Death Index.
  
  
  RESULTS
  In total, 281 (52%) men and women attended at least one CR session. There were few significant differences between non-attenders and attenders. After adjustment for age, sex, diagnosis, employment, diabetes and family history, the mortality risk for non-attenders was 58% greater than for attenders (HR=1.58, 95% CI 1.16 to 2.15). Participants who attended <25% of sessions had a mortality risk more than twice that of participants attending ≥ 75% of sessions (OR=2.57, 95% CI 1.04 to 6.38). This association was attenuated after adjusting for current smoking (OR=2.06, 95% CI 0.80 to 5.29).
  
  
  CONCLUSIONS
  This study provides further evidence for the long-term benefits of CR in a contemporary, heterogeneous population. While a dose-response relationship may exist between the number of sessions attended and long-term mortality, this relationship does not occur independently of smoking differences. CR practitioners should encourage smokers to attend CR and provide support for smoking cessation.
authors.affiliation: Heart Research Centre, Royal Melbourne Hospital, PO Box 2137, Post Office, Melbourne, VIC 3050, Australia. alison.beauchamp@heartresearchcentre.org
authors.forename: Alison
authors.initials: A
authors.lastname: Beauchamp
authors.forename: Marian
authors.initials: M
authors.lastname: Worcester
authors.forename: Andrew
authors.initials: A
authors.lastname: Ng
authors.forename: Barbara
authors.initials: B
authors.lastname: Murphy
authors.forename: James
authors.initials: J
authors.lastname: Tatoulis
authors.forename: Leeanne
authors.initials: L
authors.lastname: Grigg
authors.forename: Robert
authors.initials: R
authors.lastname: Newman
authors.forename: Alan
authors.initials: A
authors.lastname: Goble
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000534:rehabilitation; D001315:Australia; D002423:Cause of Death; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors