title: Participation in cardiac rehabilitation and survival after coronary artery bypass graft surgery: a community-based study.
abstract: BACKGROUND
  Cardiac rehabilitation (CR) is recommended for all patients after coronary artery bypass surgery, yet little is known about the long-term mortality effects of CR in this population.
  
  
  RESULTS
  We performed a community-based analysis on residents of Olmsted County, Minnesota, who underwent coronary artery bypass surgery between 1996 and 2007. We assessed the association between subsequent outpatient CR attendance and long-term survival. Propensity analysis was performed. Cox proportional hazards regression was then used to assess the association between CR attendance and all-cause mortality adjusted for the propensity to attend CR. We identified 846 eligible patients (age 66±11 years, 76% men, and 96% non-Hispanic whites) who survived at least 6 months after surgery, of whom 582 (69%) attended CR. During a mean (±SD) follow-up of 9.0±3.7 years, the 10-year all-cause Kaplan-Meier mortality rate was 28% (193 deaths). Adjusted for the propensity to attend CR, participation in CR was associated with a 10-year relative risk reduction in all-cause mortality of 46% (hazard ratio, 0.54; 95% confidence interval, 0.40-0.74; P<0.001) and a 10-year absolute risk reduction of 12.7% (number needed to treat=8). There was no evidence of a differential effect of CR on mortality with respect to age (≥65 versus <65 years), sex, diabetes, or prior myocardial infarction.
  
  
  CONCLUSIONS
  CR attendance is associated with a significant reduction in 10-year all-cause mortality after coronary artery bypass surgery. Our results strongly support national standards that recommend CR for this patient group.
authors.affiliation: Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.forename: Kashish
authors.initials: K
authors.lastname: Goel
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lahr
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.forename: Ray W
authors.initials: RW
authors.lastname: Squires
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
authors.forename: Zixin
authors.initials: Z
authors.lastname: Zhang
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000534:rehabilitation*; D003324:Coronary Artery Disease / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D012307:Risk Factors
keywords: coronary artery bypass grafting; mortality; patient compliance; propensity score; rehabilitation