This Article Figures Only Full Text Full Text (PDF) View Related Cardiosmart Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Suaya, J. A. Articles by Shepard, D. S. Search for Related Content PubMed Articles by Suaya, J. A. Articles by Shepard, D. S. Related Collections Related Articles

CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Cardiac Rehabilitation and Survival in Older Coronary Patients

Jose A. Suaya, MD, PhD^_*,_*, William B. Stason, MD, MSci^_*, Philip A. Ades, MD, Sharon-Lise T. Normand, PhD and Donald S. Shepard, PhD^_*

^_* Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts
College of Medicine, University of Vermont, Burlington, Vermont
Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

Manuscript received October 28, 2008; revised manuscript received January 20, 2009, accepted January 25, 2009.

^_* Reprint requests and correspondence: Dr. Jose A. Suaya, Schneider Institutes for Health Policy, Heller School MS 035, Brandeis University, Waltham, Massachusetts 02454-9110 (Email: suaya{at}brandeis.edu).

Objectives: This study assessed the effects of cardiac rehabilitation (CR) on survival in a large cohort of older coronary patients.

Background: Randomized controlled trials and meta-analyses have shown that CR improves survival. However, trial participants have been predominantly middle-aged, low- or moderate-risk, white men.

Methods: The population consisted of 601,099 U.S. Medicare beneficiaries who were hospitalized for coronary conditions or cardiac revascularization procedures. One- to 5-year mortality rates were examined in CR users and nonusers using Medicare claims and 3 analytic techniques: propensity-based matching, regression modeling, and instrumental variables. The first method used 70,040 matched pairs, and the other 2 techniques used the entire cohort.

Results: Only 12.2% of the cohort used CR, and those users averaged 24 sessions. Each technique showed significantly lower (p < 0.001) 1- to 5-year mortality rates in CR users than nonusers. Five-year mortality relative reductions were 34% in propensity-based matching, 26% from regression modeling, and 21% with instrumental variables. Mortality reductions extended to all demographic and clinical subgroups including patients with acute myocardial infarctions, those receiving revascularization procedures, and those with congestive heart failure. The CR users with 25 or more sessions were 19% relatively less likely to die over 5 years than matched CR users with 24 or fewer sessions (p < 0.001).

Conclusions: Mortality rates were 21% to 34% lower in CR users than nonusers in this socioeconomically and clinically diverse, older population after extensive analyses to control for potential confounding. These results are of similar magnitude to those observed in published randomized controlled trials and meta-analyses in younger, more selected populations.

Key Words: cardiac rehabilitation • coronary heart disease • AMI • CABG • elderly

Abbreviations and Acronyms   AMI = acute myocardial infarction   CABG = coronary artery bypass graft   CHD = coronary heart disease   CHF = congestive heart failure   CR = cardiac rehabilitation   IV = instrumental variable   PCI = percutaneous coronary intervention

Related Articles

Analysis Methods for Observational Studies: Effects of Cardiac Rehabilitation on Mortality of Coronary Patients

Therese A. Stukel and David A. Alter
J. Am. Coll. Cardiol. 2009 54: 34-35. [Full Text] [PDF]

This article has been cited by other articles:

				M. Casper, I. Nwaise, J. B. Croft, Y. Hong, J. Fang, and S. Greer Geographic Disparities in Heart Failure Hospitalization Rates Among Medicare Beneficiaries J. Am. Coll. Cardiol., January 26, 2010; 55(4): 294 - 299. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, et al. Highlights of the Year in JACC 2009 J. Am. Coll. Cardiol., January 26, 2010; 55(4): 380 - 407. [Full Text] [PDF]

				B. G. Hammill, L. H. Curtis, K. A. Schulman, and D. J. Whellan Relationship Between Cardiac Rehabilitation and Long-Term Risks of Death and Myocardial Infarction Among Elderly Medicare Beneficiaries Circulation, January 5, 2010; 121(1): 63 - 70. [Abstract] [Full Text] [PDF]

				D R Thompson and A M Clark Cardiac rehabilitation: into the future Heart, December 1, 2009; 95(23): 1897 - 1900. [Abstract] [Full Text] [PDF]

				T. A. Stukel and D. A. Alter Analysis methods for observational studies effects of cardiac rehabilitation on mortality of coronary patients. J. Am. Coll. Cardiol., June 30, 2009; 54(1): 34 - 35. [Full Text] [PDF]