Rehabilitation in Patients With Coronary Heart Disease: Participation and Its Effect on Prognosis.
BACKGROUND
In Germany, rehabilitation is considered to be indicated after an acute hospital stay for the treatment of a severe cardiac condition. In comparative studies, at least 51% of German hospital patients with coronary heart disease (CHD) who were entitled to rehabilitative measures actually took part n rehabilitation.


METHODS
We examined data on 1910 patients with CHD who took part in two prospective cohort studies at the University Hospital of Halle (Saale) in the years 2007-2011. We contacted these patients again with a questionnaire to determine which ones had undergone rehabilitation. For patients who died before we could contact them, the attempt was made to obtain the dates and causes of death from the local authorities. The primary endpoint of was overall mortality.


RESULTS
The median duration of follow-up was 136 ± 71 weeks. 727 patients (38.1%) had applied for rehabilitation during their acute hospitalization, but only 552 patients (28.9%) actually underwent it. Patients who did not undergo rehabilitation were older than those who did (68.6 ± 10.3 vs. 64.9 ± 10.5 years) and suffered more commonly from diabetes (41.3% vs. 33.7%; p = 0.002), arterial hypertension (89.2% vs. 85.3%; p = 0.017), and peripheral arterial occlusive disease (15.3% vs. 9.8%; p = 0.002). There were more smokers in the rehabilitation group. Kaplan-Meier analysis and multivariate Cox regression analysis both showed that the patients who underwent rehabilitation had lower mortality (hazard ratio 0.067, 95% confidence interval 0.025-0.180, p < 0.001).


CONCLUSIONS
Rehabilitation for cardiac patients was associated with lower mortality. Fewer patients underwent rehabilitation in this study than in other, comparable studies. Those who did not were older and had a greater burden of accompanying disease.
Paracelsus Harz Clinic Bad Suderode, Quedlinburg, Department of Internal Medicine III, University Hospital of Halle (Saale), Institute for Medical Epidemiology, Biometrics and Computer Science, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Department of Internal Medicine I, University Hospital of Halle (Saale), Department of Cardiac und Thoracic Surgery, University Hospital of Halle (Saale).
Axel
A
Schlitt
Patricia
P
Wischmann
Andreas
A
Wienke
Florian
F
Hoepfner
Frank
F
Noack
Rolf-Edgar
RE
Silber
Karl
K
Werdan
D017677:Age Distribution; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000401:mortality / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome