Cardiac rehabilitation completion is associated with reduced mortality in patients with diabetes and coronary artery disease.
OBJECTIVE
Cardiac rehabilitation (CR) reduces the risks of mortality and hospitalisation in patients with coronary artery disease and without diabetes. It is unknown whether patients with diabetes obtain the same benefits from CR.


METHODS
We retrospectively examined patients referred to a 12 week CR programme between 1996 and 2010. Associations between CR completion vs non-completion and death, hospitalisation rate and cardiac hospitalisation rate were assessed by survival analysis.


RESULTS
Over the study period, 13,158 participants were referred to CR (mean ± SD, age 59.9 ± 11.1 years, 28.9% female, 2,956 [22.5%] with diabetes). Patients with diabetes were less likely to complete CR than those without diabetes (41% vs 56%, p < .0001). Over a median follow-up of 6.6 years, there were 379 deaths in patients with diabetes vs 941 deaths among those without diabetes (12.8% vs 8.9%). Of the non-completers, patients with diabetes had a higher mortality rate compared with those without diabetes (17.7% vs 11.3%). In patients who completed CR, mortality was lower: 11.1% in patients with diabetes vs 7.0% in those without diabetes. In patients with diabetes, CR completion was associated with reduced mortality (HR 0.46 [95% CI 0.37, 0.56]), reduced hospitalisation (HR 0.86 [95% CI 0.76, 0.96]) and reduced cardiac hospitalisation (HR 0.67 [95% CI 0.54, 0.84]). The protective associations were similar to those of patients without diabetes. In multivariable adjusted analyses, all of these associations remained significant.


CONCLUSIONS
Patients with diabetes were less likely to complete CR than those without diabetes. However, patients with diabetes who completed CR derived similar apparent reductions in mortality and hospitalisation to patients without diabetes.
Cardiovascular and Respiratory Sciences, Cumming School of Medicine, Diabetes Clinical Trials Unit, 1820 Richmond Road SW, Calgary, AB, T2T 5C7, Canada, marni.armstrong@ucalgary.ca.
Marni J
MJ
Armstrong
Ronald J
RJ
Sigal
Ross
R
Arena
Trina L
TL
Hauer
Leslie D
LD
Austford
Sandeep
S
Aggarwal
James A
JA
Stone
Billie-Jean
BJ
Martin
D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome