title: Cardiac rehabilitation following an acute coronary syndrome: Trends in referral, predictors and mortality outcome in a multicenter national registry between years 2006-2013: Report from the Working Group on Cardiac Rehabilitation, the Israeli Heart Society.
abstract: Background Utilization of cardiac rehabilitation is suboptimal. The aim of the study was to assess referral trends over the past decade, to identify predictors for referral to a cardiac rehabilitation program, and to evaluate the association with one-year mortality in a large national registry of acute coronary syndrome patients. Design and methods Data were extracted from the Acute Coronary Syndrome Israeli Survey national surveys between 2006-2013. A total of 6551 patients discharged with a diagnosis of acute coronary syndrome were included. Results Referral to cardiac rehabilitation following an acute coronary syndrome increased from 38% in 2006 to 57% in 2013 ( p for trend < 0.001). Multivariate modeling identified the following independent predictors for non-referral: 2006 survey, older age, female sex, past stroke, heart or renal failure, prior myocardial infarction, minority group, and lack of in-hospital cardiac rehabilitation center (all p < 0.01). Kaplan-Meier survival analyses showed one-year survival rates of 97% vs 92% in patients referred for cardiac rehabilitation as compared to those not referred (log-rank p < 0.01). Multivariate analysis showed that referral for cardiac rehabilitation was associated with a 27% mortality risk reduction at one-year follow-up ( p = 0.03). Consistently, a 32% lower one-year mortality risk was evident in a propensity score matched group of 3340 patients (95% confidence interval 0.48-0.95, p = 0.02). Conclusions Over the past decade there was a significant increase in cardiac rehabilitation referral following an acute coronary syndrome. However, cardiac rehabilitation is still under-utilized in important high-risk subsets of this population. Patients referred to cardiac rehabilitation have a lower adjusted mortality risk.
authors.affiliation: 1 The Leviev Heart Center, Sheba Medical Center, Israel.
authors.forename: Fernando
authors.initials: F
authors.lastname: Chernomordik
authors.affiliation: 1 The Leviev Heart Center, Sheba Medical Center, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Sabbag
authors.affiliation: 1 The Leviev Heart Center, Sheba Medical Center, Israel.|2 Cardiac Rehabilitation Institute, Sheba Medical Center, Israel.
authors.forename: Boaz
authors.initials: B
authors.lastname: Tzur
authors.affiliation: 3 Public Health Department, Ministry of Health, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Kopel
authors.affiliation: 1 The Leviev Heart Center, Sheba Medical Center, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Goldkorn
authors.affiliation: 1 The Leviev Heart Center, Sheba Medical Center, Israel.|4 Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.affiliation: 1 The Leviev Heart Center, Sheba Medical Center, Israel.|4 Sackler School of Medicine, Tel Aviv University, Israel.|5 The Israeli Association for Cardiovascular Trials, Sheba Medical Center, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: 5 The Israeli Association for Cardiovascular Trials, Sheba Medical Center, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: 1 The Leviev Heart Center, Sheba Medical Center, Israel.|2 Cardiac Rehabilitation Institute, Sheba Medical Center, Israel.|4 Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D016009:Chi-Square Distribution; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000639:trends*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000639:trends*; D012042:Registries; D012307:Risk Factors; D055502:Secondary Prevention / Q000639:trends*; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac rehabilitation; acute coronary syndromes; coronary heart disease; mortality; myocardial infarction; referral; secondary prevention