Rehabilitation in Patients With Coronary Heart Disease: Participation and Its Effect on Prognosis

In Germany, rehabilitation is considered to be indicated after an acute hospital stay for the treatment of a severe cardiac condition. In comparative studies, at least 51% of German hospital patients with coronary heart disease (CHD) who were entitled to rehabilitative measures actually took part n rehabilitation.

We examined data on 1910 patients with CHD who took part in two prospective cohort studies at the University Hospital of Halle (Saale) in the years 2007-2011. We contacted these patients again with a questionnaire to determine which ones had undergone rehabilitation. For patients who died before we could contact them, the attempt was made to obtain the dates and causes of death from the local authorities. The primary endpoint of was overall mortality.

The median duration of follow-up was 136 ± 71 weeks. 727 patients (38.1%) had applied for rehabilitation during their acute hospitalization, but only 552 patients (28.9%) actually underwent it. Patients who did not undergo rehabilitation were older than those who did (68.6 ± 10.3 vs. 64.9 ± 10.5 years) and suffered more commonly from diabetes (41.3% vs. 33.7%; p = 0.002), arterial hypertension (89.2% vs. 85.3%; p = 0.017), and peripheral arterial occlusive disease (15.3% vs. 9.8%; p = 0.002). There were more smokers in the rehabilitation group. Kaplan-Meier analysis and multivariate Cox regression analysis both showed that the patients who underwent rehabilitation had lower mortality (hazard ratio 0.067, 95% confidence interval 0.025-0.180, p < 0.001).

Rehabilitation for cardiac patients was associated with lower mortality. Fewer patients underwent rehabilitation in this study than in other, comparable studies. Those who did not were older and had a greater burden of accompanying disease.