Referral for cardiac rehabilitation after acute myocardial infarction: Insights from nationwide AMIS Plus registry 2005–2017
Section snippets
Background
Cardiac rehabilitation (CR) plays an important role in secondary prevention after acute coronary syndromes and has a Class I recommendation in the recent European STEMI and NSTEMI guidelines [[1], [2], [3]]. Furthermore, CR is recommended in stable CAD patients with or without elective PCI [4]. Cardiac rehabilitation after myocardial infarction and/or myocardial revascularization is associated with lower cardiovascular mortality, re-hospitalisation, coronary revascularization, and
Study design
This analysis was performed using data from the AMIS Plus registry. AMIS Plus is an ongoing nationwide prospective registry of patients admitted with ACS to Swiss hospitals, founded 1997 by the Swiss Societies of Cardiology, Internal Medicine and Intensive Care. Details were previously described [13,14]. From 106 centres treating ACS patients in Switzerland, 83 centres have been collecting temporally or continuously data for the AMIS Plus project. Participating centres range from
Patient characteristics
Between January 2005 and March 2017, 34,789 patients with AMI were enrolled, excluding patients who suffered their MI during a hospitalisation for another disease. 32,416 (93.2%) patients had data on further proceeding at discharge of which 10,940 (33.7%) had a recommendation for inpatient or outpatient cardiac rehabilitation (CR) at discharge. For 12,282 (37.9%) patients it was indicated that they went home after hospitalisation. Patients who were transferred after initial AMI treatment to
Discussion
In our present study we identified important predictors for a referral to for CR in patient after STEMI or NSTEMI in Switzerland. In particular, a performed PCI, Killip class 3 or 4 and complications during hospitalisation such as cardiogenic shock, reinfarction or cerebrovascular events were strong independent predictors. Interestingly, age >65 years and previous known atherosclerotic disease, such as previous myocardial infarction, previous revascularisation, cerebrovascular disease or
Conclusions
Despite given limitations, our present study characterized patients and identified predictors for participation and non-participation in CR programs from the large scale AMIS Plus registry in Switzerland. In particular, disparities exist for age and gender with significantly younger patients and less women being referred. High risk patients with pre-existing coronary or cerebrovascular disease as well as the elderly and women should not be distracted from the benefits of a cardiac
Author contributions
MH, FW and DR: conception, data interpretation and manuscript drafting
FW, DR: acquisition and analysis of data
PE and HR: critical revision of the manuscript draft
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Declaration of conflicting interests
The Authors declare that there is no conflict of interest. The authors report no relationships that could be construed as a conflict of interest
References (23)
- et al.
Gaps in referral to cardiac rehabilitation of patients undergoing percutaneous coronary intervention in the United States
J. Am. Coll. Cardiol.
(2015) - et al.
Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis
J. Am. Coll. Cardiol.
(2016) - et al.
Comparison of in-hospital mortality for acute myocardial infarction in Switzerland with admission during routine duty hours versus admission during out of hours (insight into the AMIS plus registry)
Am. J. Cardiol.
(2008) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J. Chronic Dis.
(1987) - et al.
ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation
Eur. Heart J.
(2012) - et al.
2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)
Eur. Heart J.
(2016) - et al.
Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology
Eur. J. Prev. Cardiol.
(2014) - et al.
Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation
Eur. Heart J.
(2010) - et al.
Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey
Eur. J. Cardiovasc. Prev. Rehabil.
(2010) - et al.
EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries
Eur. J. Prev. Cardiol.
(2016)
Predictors of enrollment in cardiac rehabilitation programs in Spain
J. Cardiopulm. Rehabil. Prev.
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