Wednesday, August 29, 2018 Study: Listen to the CPGs—Cardiac Rehab Works The clinical practice guidelines are right: Ambulatory cardiac rehabilitation (CR) should be routine for patients with cardiovascular events such as myocardial infarction, say authors of a study in the European Heart Journal (abstract only available for free). However, despite evidence of its effectiveness—including a nearly 50% drop all-cause mortality for patient who receive CR—CR “remains significantly underused,” they write. Authors compared the long-term outcomes of an early discharge CR program for patients with ST-elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, planned percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) versus no CR at all. At one hospital, all 839 patients received early CR; at a second, none of the 441 patients received CR, as it was not available. The hospitals were in the same geographic area. The CR program included evaluations, cycle-ergometer tests, and echocardiograms for all patients. Patients with STEMI or CABG received 5 weeks of exercise bicycle training followed by 6 weeks of gym training, supervised by a nurse and a physical therapist. The program was tailored to each patient’s needs. After a 5-year follow-up period, researchers analyzed the data to account for confounding demographic variables and found: All-cause mortality in the CR group was lower (10%) compared to the non-CR group (19%). Cardiovascular mortality was 2% for the CR group and 7% for the non-CR group. Hospitalization for cardiovascular causes was lower for the CR group (11% for the CR group, 25% for the non-CR group). Combined hospitalization for cardiovascular causes and cardiovascular mortality was 13% for the CR group, compared with 29% for the non-CR group. Authors think that the CR method used for their study "can be adopted without the use of expensive resources and can be applied in any ambulatory CR center," thus making it easier for CR to become more widespread. And it's that the lack of widespread use of CR that's the problem, they note. "Despite these evidences supporting the benefits of CR programs, this service is greatly underutilized, especially by women, elderly, and diabetic patients," authors write. "Referral and participation range is between 30% and 50% in Europe and it is around 25% in [the United States]."