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J Am Coll Cardiol, 2004; 44:988-996, doi:10.1016/j.jacc.2004.05.062 © 2004 by the American College of Cardiology Foundation |
,*
* Divisions of Cardiovascular Diseases and Internal Medicine, Rochester, Minnesota, USA
Division of Epidemiology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
Division of Biostatistics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
Manuscript received February 4, 2004; revised manuscript received May 11, 2004, accepted May 18, 2004.
* Reprint requests and correspondence: Dr. Véronique L. Roger, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: roger.veronique{at}mayo.edu).
OBJECTIVES: The aim of this study was to examine participation in cardiac rehabilitation after myocardial infarction (MI) by age and gender and the association of participation with survival.
BACKGROUND: Lesser participation in cardiac rehabilitation has been reported for women and the elderly.
METHODS: All incident MIs in Olmsted County were validated. Baseline characteristics and outcomes were ascertained from the medical record. Logistic regression examined the association between participation, age, and gender. Propensity scores were used to examine the association between participation and outcome.
RESULTS: Among 1,821 persons with incident MI (58% men, 46% age >70 years), 55% participated in cardiac rehabilitation. Participants were more likely to be men, younger, and have fewer comorbidities (p < 0.01 for all comparisons). After adjustment, women were 55% less likely to participate than men (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.34 to 0.60), and persons 70 years or older were 77% less likely to participate than persons younger than 60 (OR 0.23, 95% CI 0.16 to 0.33). Participants had a lower risk of death and recurrent MI at three years (p < 0.001 and p = 0.049, respectively). The survival benefit associated with participation was stronger in more recent years (relative risk [RR] for 1998 vs. 1982 0.28, 95% CI 0.18 to 0.43; RR for 1990 vs. 1982 0.41, 95% CI 0.33 to 0.52).
CONCLUSIONS: Approximately half of the patients participated in cardiac rehabilitation after MI. Participation did not increase over time. Women and elderly persons were less likely to participate, independently of other characteristics. Participation in rehabilitation was independently associated with decreased mortality and recurrent MI, and its protective effect was stronger in more recent years.
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