title: Outcomes associated with cardiac rehabilitation participation in patients with musculoskeletal comorbidities.
abstract: BACKGROUND
  Individuals with coronary artery disease (CAD) and musculoskeletal comorbidities (MSKCs) have much to gain from physical activity, yet are less likely to be referred to cardiac rehabilitation (CR) than those without MSKCs. Whether patients with MSKCs achieve demonstrated benefits of CR participation such as improved quantity and quality-of-life remains unknown.
  
  
  OBJECTIVE
  To compare all-cause mortality, major acute cardiovascular events (MACEs), quality-of-life and psychosocial well-being in patients with CAD and coexisting MSKCs by CR participation.
  
  
  METHODS
  Prospective and observational study in which patients were administered a questionnaire in the hospital and 1 year later. The cohort was linked to provincial databases.
  
  
  METHODS
  Eleven hospitals in Ontario, Canada.
  
  
  METHODS
  CAD patients (N.=1680).
  
  
  METHODS
  CAD inpatients were administered a questionnaire assessing sociodemographic and clinical characteristics. Clinical data were extracted from charts. CR participation, quality-of-life, depressive symptoms, functional status, and physical activity behavior were measured 1 year later by questionnaire. The cohort was linked to provincial administrative databases to ascertain mortality and MACEs for a median of 2.7 years post-index cardiac hospitalization. Associations of CR participation with outcomes were tested after adjustment for differences in participation propensity.
  
  
  RESULTS
  Of study participants, 50.7% (851/1680) had MSKCs and of those with MSKCs, 49.8% (424/851) participated in CR. Patients with MSKCs who participated in CR had greater physical quality-of-life (P<0.03) and lower mortality than those with MSKCs who did not attend CR, after adjusting for propensity for CR participation (1.4% vs. 4%; participant vs. non-participants, P=0.03) - non-participants' hazard ratio 3.91 [95%CI,1.23-12.36]). There were no differences for MACEs.
  
  
  CONCLUSIONS
  Among those with MSKCs, participation in CR is associated with survival benefit and better physical quality-of-life compared to non-participants.
  
  
  CONCLUSIONS
  Our findings showing the high prevalence of MSKCs in those with CAD and the benefits of CR, add to the literature that will provide the basis for exploration of initiatives to improve care for those with CAD and MSKC, and to overcome barriers to improved outcomes and reduced death. These results will help to guide focused research to optimize complex outpatient care in this group, including increasing the utilization of CR.
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, Canada - susan.marzolini@uhn.ca.
authors.forename: S
authors.initials: S
authors.lastname: Marzolini
authors.forename: Y M
authors.initials: YM
authors.lastname: Leung
authors.forename: D A
authors.initials: DA
authors.lastname: Alter
authors.forename: G
authors.initials: G
authors.lastname: Wu
authors.forename: S L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality / Q000534:rehabilitation*; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D011446:Prospective Studies; D011788:Quality of Life