title: Cardiac rehabilitation is associated with reduced long-term mortality in patients undergoing combined heart valve and CABG surgery.
abstract: BACKGROUND
  No reports have been published to date on the impact of cardiac rehabilitation (CR) on mortality in patients undergoing combined heart valve and coronary artery bypass graft (CABG) surgery (V + CABG), a procedure that has increased significantly in frequency in recent years.
  
  
  METHODS
  We identified consecutive patients who underwent V + CABG surgery in the Olmsted County from 1996 to 2007. Propensity scores were developed using more than 40 clinical, operative, and post-operative characteristics. The impact of CR on long-term mortality was assessed via landmark analysis and using propensity score regression adjustment and stratification techniques.
  
  
  RESULTS
  A total of 201 patients were included in our study, in whom 86 deaths occurred over a mean follow up of 6.8 years. Forty-seven per cent of patients participated in CR, with a significant trend towards increased participation in recent years (p = 0.04). Conditional on 6-month survival and controlling for propensity factors as well as mortality risk factors, CR participation was associated with a significant reduction in mortality (propensity score adjustment: HR 0.48, p = 0.009; propensity score stratification: HR 0.48, p = 0.016). The absolute risk reduction over 10 years was 14.5% (number needed to treat = 7). Results did not differ significantly based on age, gender, emergent status, or history of heart failure or arrhythmias, but CR participation was more beneficial for patients who underwent a mitral valve procedure (HR 0.24, 95% CI 0.08-0.77).
  
  
  CONCLUSIONS
  This is the first study reporting a significant survival benefit with CR participation in patients who have undergone combined V + CABG surgery. These findings provide evidence in support of recommendations for CR participation after V + CABG surgery.
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Kashish
authors.initials: K
authors.lastname: Goel
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Lahr
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Squires
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Zixin
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Mayo Clinic, Rochester, MN, USA Thomas.randal@mayo.edu.
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000534:rehabilitation*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods; D015996:Survival Rate
keywords: Cardiac rehabilitation; cardiac surgery; mortality; propensity score; secondary prevention