title: Changes in risk factors and exercise capacity after cardiac rehabilitation and its effect on hospital readmission.
abstract: BACKGROUND
  Despite the positive outcomes reported with cardiac rehabilitation (CR), its impacts have been reported to be different from a region or country to another, which may be due to the different contents of rehabilitation programs.
  
  
  OBJECTIVE
  To investigate the effect of CR on cardiovascular risk factors.
  
  
  METHODS
  This is a retrospective cohort study on the data from Imam Ali Cardiac Rehabilitation Center in Kermanshah province, Iran from 2001 to 2008. We used paired t-test to evaluate the effect of CR on cardiovascular risk factors. Logistic regression or t-test (unequal variance) were used to assess the factors influencing re-admission (due to cardiac problems). The relationship between different variables and death was studied using univariate cox proportional hazard. P values < 0.05 were considered significant for all analyses.
  
  
  RESULTS
  Out of 504 patients who completed rehabilitation, a total of 499 were analyzed. These 499 patients consisted of 383 men and 116 women. All anthropometric measurements, blood lipids (except HDL cholesterol), systolic and diastolic blood pressure, depression, anxiety and exercise capacity improved after rehabilitation (P < 0.05 for all cases). The improvement was observed in both sexes. A total of 39 patients were re-admitted to hospital after rehabilitation. Being female (OR = 2.40; 95%CI: 1.22-4.68) and history of diabetes (OR = 2.04; 95%CI: 1.04-4.02) increased the risk of re-admission significantly. Patients who were readmitted had higher anthropometric measurements at the beginning and the end of the program. Moreover, the initial exercise capacity of readmitted patients was lower than those who were not readmitted. After a maximal follow-up period of 6.3 years (median = 2.99 years), only eight patients expired (survival rate: 97.5%; 95%CI: 94.7-98.8). None of the variables in our study was significantly related to the survival rate.
  
  
  CONCLUSIONS
  The comprehensive CR program in Imam Ali Center efficiently reduces cardiovascular risk factors and improves exercise capacity.
authors.affiliation: Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Najafi
authors.affiliation: Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nalini
authors.affiliation: School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Nikbakht
keywords: Exercise Tolerance; Patient Readmission; Rehabilitation; Risk Factors