title: Survey Reported Participation in Cardiac Rehabilitation and Survival After Mitral or Aortic Valve Surgery.
abstract: We sought to measure the impact of cardiac rehabilitation (CR) on mortality in patients with mitral or aortic heart valve surgery (HVS) and nonobstructive coronary artery disease. We surveyed all patients (or a close family member if the patient was deceased) who had HVS without coronary artery bypass in 2006 through 2010 at the Mayo Clinic to assess if they attended CR after their HVS. We performed a propensity-adjusted landmark analysis to test the association between CR attendance and long-term all-cause mortality conditional on surviving the first year after HVS. Survey response rate was 40% (573/1,420), with responders more likely to be older, have longer hospitalizations, and have more aortic valve disease. A total of 547 patients (59% aortic surgery, ejection fraction 64%) with valid survey responses and 1-year follow-up were included in the propensity analysis, of whom 296 (54%) attended CR. There were 100 deaths during a median follow-up of 5.8 years. For all patients, the propensity-adjusted model suggested no impact of CR on mortality (hazard ratio [HR] 1.03, 95% CI 0.66 to 1.62). When stratified by procedure, results suggested a potentially favorable, but nonsignificant, effect in patients with mitral valve surgery (HR 0.49, 95% CI 0.15 to 1.56), but not in patients with aortic valve surgery (HR 1.00, 95% CI 0.61 to 1.64.) In conclusion, we found no survival advantage for patients with normal preoperative ejection fraction who attended CR after surgical "correction" of their severe aortic or mitral valve disease.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts. Electronic address: Quinn.PackMD@baystatehealth.org.
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lahr
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Squires
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
authors.affiliation: Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hector I
authors.initials: HI
authors.lastname: Michelena
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kashish
authors.initials: K
authors.lastname: Goel
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
mesh_terms: D000368:Aged; D001021:Aortic Valve; D000072038:Cardiac Rehabilitation / Q000706:statistics & numerical data*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D008943:Mitral Valve; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends