title: Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study.
abstract: BACKGROUND
  Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality.
  
  
  OBJECTIVE
  To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI).
  
  
  METHODS
  Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model.
  
  
  RESULTS
  At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40).
  
  
  CONCLUSIONS
  After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Pouche
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France. Electronic address: jean-bernard.ruidavets@univ-tlse3.fr.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France; Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: Department of Cardiac Rehabilitation, AP-HP, Corentin-Celton Hospital, 92130 Issy-les Moulineaux, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Iliou
authors.affiliation: Department of Cardiology, Bordeaux University Hospital, 33604 Pessac, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Douard
authors.affiliation: Department of Cardiology, University Hospital, Laboratory of Cardiometabolic Physiopathology and Pharmacology, Inserm U866, University of Burgundy, 21034 Dijon, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
authors.affiliation: Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.affiliation: Department of Cardiology, Nouvelles Cliniques Nantaises, 44277 Nantes cedex 2, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brunel
authors.affiliation: Department of Pharmacology and Clinical Research Unit (URCEST), AP-HP, Saint-Antoine Hospital, Pierre-and-Marie-Curie University (UPMC-Paris 06), Inserm U970, 75012 Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bataille
authors.affiliation: Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, René-Descartes University, Inserm U970, 75908 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012017:Referral and Consultation; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Cardiac rehabilitation; Infarctus du myocarde aigu; Infarctus du myocarde avec sus-décalage du segment ST; Infarctus du myocarde sans sus-décalage du segment ST; Mortality; Mortalité; Non–ST-segment elevation myocardial infarction; Réadaptation cardiaque; ST-segment elevation myocardial infarction