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[Ambulatory cardiac rehabilitation in Trieste: protocols of intervention, activities and outcomes]
Sara Doimo1, Patrizia Maras1, Giulia Barbati1
1Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare.
Insights
Cardiac rehabilitation (CR) is feasible in diverse patient groups, improving secondary prevention outcomes. This ambulatory CR program demonstrated good results in reducing hospitalizations and mortality for coronary artery disease patients.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiac rehabilitation (CR) is a proven intervention for reducing mortality and morbidity in coronary artery disease (CAD) patients.
- The study describes an ambulatory CR model implemented in Trieste, Italy.
- Analysis focuses on the outcomes of a diverse patient population undergoing CR.
Purpose of the Study:
- To describe the ambulatory cardiac rehabilitation model at the Cardiovascular Department of Trieste.
- To analyze the outcomes of patients undergoing this CR program.
- To assess the feasibility and effectiveness of CR in an unselected population.
Main Methods:
- Retrospective analysis of clinical and instrumental data from 3088 consecutive patients (2009-2015).
- Patients included those with ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), coronary artery bypass graft (CABG/CABGV), or percutaneous coronary intervention (PCI).
- Outcomes assessed included new cardiovascular hospitalizations during and after CR, and total and cardiovascular mortality at long-term follow-up.
Main Results:
- The CR program served 3088 patients (mean age 70±11 years, 28% female), with high prevalence of risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities.
- At CR completion, patients achieved secondary prevention targets (e.g., LDL cholesterol <85 mg/dl, HbA1c <7.2%).
- Hospitalizations during CR were 11% (1% within 1 year post-CR), and overall mortality was 11% (3% cardiovascular), with higher cardiovascular mortality in elderly, women, diabetics, and those with left ventricular dysfunction.
Conclusions:
- The ambulatory CR program is feasible in an unselected population with advanced age, risk factors, and comorbidities.
- The CR model achieved good results in secondary prevention and patient outcomes.
- Registry data analysis facilitated critical evaluation and improvement of CR program effectiveness.
Background:
Cardiac rehabilitation (CR) is a model of care proven to reduce mortality and morbidity in patients with coronary artery disease. The aim of this study is to describe the ambulatory CR model of the Cardiovascular Department of Trieste (Italy), analyzing the outcome of the population.
Methods:
We analyzed clinical and instrumental characteristics of all consecutive patients after ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), coronary artery bypass graft with or without valve surgery (CABG/CABGV), or planned percutaneous coronary intervention (PCI), referred for CR from January 1, 2009, to December 31, 2015. All patients were included in a registry. During CR and at 1-year follow-up, the incidence of new hospitalizations due to cardiovascular causes was assessed. Total and cardiovascular mortality was also evaluated at longer follow-up.
Results:
Overall, 3088 patients (28% female, mean age 70 ± 11 years; 35% older than 75 years) were referred for CR, 30% after STEMI, 23% after NSTEMI, 29% after CABG/CABGV, and 19% after PCI. At enrollment, 9% of patients had an ejection fraction <40%, 76% were hypertensive, 61% dyslipidemic, 19% diabetics, and 27% smokers. CR lasted 5 ± 4 months. At the end of the CR program, 96% of patients were on antiplatelets, 79% on beta-blockers, 73% on angiotensin-converting enzyme inhibitors, 25% on angiotensin II receptor blockers, and 87% on statins with achievement of the following secondary prevention targets: LDL cholesterol 85 ± 30 mg/dl, glycated hemoglobin 7.2 ± 4%, heart rate 64 ± 11 bpm, systolic/diastolic blood pressure 137 ± 32/78 ± 14 mmHg. During CR, new hospitalizations occurred in 11% of patients, 1% within 1 year after CR. At a mean follow-up of 4.4 ± 2 years, 11% of patients died, 3% for cardiovascular causes, 0.7% within 1 year. Cardiovascular mortality was significantly higher in elderly patients (6 vs 2%, p=0.000), women (4 vs 3%, p=0.038), diabetics (5 vs 3%, p=0.004), and in patients with left ventricular dysfunction (8 vs 3%, p=0.000).
Conclusions:
Our findings show the feasibility of a CR program in an unselected population, characterized by advanced age, risk factors and comorbidities. A critical analysis of the registry data allowed us to achieve good results in secondary prevention and outcomes.
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