title: Cardiac rehabilitation and survival in a large representative community cohort of Dutch patients.
abstract: OBJECTIVE
  To assess the effects of multi-disciplinary cardiac rehabilitation (CR) on survival in the full population of patients with an acute coronary syndrome (ACS) and patients that underwent coronary revascularization and/or heart valve surgery.
  
  
  RESULTS
  Population-based cohort study in the Netherlands using insurance claims database covering ∼22% of the Dutch population (3.3 million persons). All patients with an ACS with or without ST elevation, and patients who underwent coronary revascularization and/or valve surgery in the period 2007-10 were included. Patients were categorized as having received CR when an insurance claim for CR was made within the first 180 days after the cardiac event or revascularization. The primary outcome was survival time from the inclusion date, limited to a total follow-up period of 4 years, with a minimum of 180 days. Propensity score weighting was used to control for confounding by indication. Among 35 919 patients with an ACS and/or coronary revascularization or valve surgery, 11 014 (30.7%) received CR. After propensity score weighting, the adjusted hazard ratio (HR) associated with receiving CR was 0.65 (95% CI 0.56-0.77). The largest benefit was observed for patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery (HR = 0.55, 95% CI 0.42-0.74).
  
  
  CONCLUSIONS
  In a large and representative community cohort of Dutch patients with an ACS and/or intervention, CR was associated with a substantial survival benefit up to 4 years. This survival benefit was present regardless of age, type of diagnosis, and type of intervention.
authors.affiliation: Actuarial Department, Achmea Zorg en Gezondheid, Leiden, The Netherlands Research for Decisions, Utrecht, The Netherlands.
authors.forename: Han
authors.initials: H
authors.lastname: de Vries
authors.affiliation: Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands.
authors.forename: Hareld M C
authors.initials: HM
authors.lastname: Kemps
authors.affiliation: Department of Medical Informatics, Academic Medical Center/University of Amsterdam, Room number J1b-110, PO 22660, Amsterdam 1100 DD, The Netherlands.
authors.forename: Mariette M
authors.initials: MM
authors.lastname: van Engen-Verheul
authors.affiliation: NIPED (Netherlands Institute for Prevention and E-Health Development) Research Foundation, Amsterdam CardioVitaal Cardiac Rehabilitation Center, Amsterdam.
authors.forename: Roderik A
authors.initials: RA
authors.lastname: Kraaijenhagen
authors.affiliation: Department of Medical Informatics, Academic Medical Center/University of Amsterdam, Room number J1b-110, PO 22660, Amsterdam 1100 DD, The Netherlands MRC Health e-Research Centre, Institute of Population Health, University of Manchester, UK n.b.peek@amc.uva.nl.
authors.forename: Niels
authors.initials: N
authors.lastname: Peek
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery; D000368:Aged; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000534:rehabilitation; D009426:Netherlands / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Cardiac rehabilitation; Coronary artery disease; Observational study; Outcomes research; Survival