Referral for cardiac rehabilitation after acute myocardial infarction: Insights from nationwide AMIS Plus registry 2005–2017

https://doi.org/10.1016/j.ijcard.2018.01.096Get rights and content

Highlights

  • Data from 23’222 patients after AMI are included in our analysis

  • Patients referred for CR are younger, more male, more obese with more STEMI.

  • Hypertension, dyslipidemia and diabetes were less present in CR patients

  • In-hospital complications were strong predictors for CR recommendation.

  • Patients with pre-existing coronary or cerebrovascular disease as well as the elderly and women should not be distracted from benefits of CR.

Abstract

Background

Referral rates for cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) are low despite a Class I recommendation in the present guidelines. Therefore, we aimed to identify predictors for referral and patient characteristics from the national Swiss AMIS Plus registry.

Design and methods

Data were extracted from the Swiss AMIS Plus registry between 2005 and 2017, which included patients with ST-elevation myocardial infarction (STEMI) and Non-ST-elevation myocardial infarction (NSTEMI). For 32,416 patient (93.2%) data about destination at discharge were available with 10,940 (33.7%) having a recommendation for CR while 12,282 (37.9%) went home. 9194 (28.4%) were transferred to another hospital after index hospitalisation and were excluded.

Results

Patients referred to CR were younger (62.6 vs. 68.2 years) and had a higher prevalence of obesity (22.0% vs. 20.4%). Except for smoking (44.0% vs 34.9%), they had less risk factors such as dyslipidemia (55.0% vs. 60.1%), hypertension (55.6% vs. 65.3%) and diabetes (16.7% vs. 21.5%). Patients with in-hospital complications were more likely being referred for CR. Furthermore, STEMI (OR 1.61; CI 1.52–1.71), performed PCI (OR 2.65; CI 2.42–2.90) and Killip class >2 (OR 1.58; CI 1.36–1.84) favoured referral for CR, while age > 65 years, previous myocardial infarction, cerebrovascular disease or peripheral artery disease had a negative impact on referral for CR.

Conclusions

Our data from 23,222 patients after AMI demonstrate that in Switzerland patients referred for CR are younger, more obese with more STEMI. In-hospital complications were strong predictors for CR recommendation. Unlike anticipated, other risk factors were less present in CR patients.

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

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