Related Experiment Video
Updated: Dec 13, 2025
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Association of Cardiac Rehabilitation With All-Cause Mortality Among Patients With Cardiovascular Disease in the
Thijs M H Eijsvogels1, Martijn F H Maessen1,2, Esmée A Bakker1,3
1Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
Insights
Cardiac rehabilitation (CR) significantly lowers mortality risk for cardiovascular disease (CVD) patients by 32%. This benefit is consistent across various demographics, underscoring CR
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiac rehabilitation (CR) is a proven intervention for improving outcomes in cardiovascular disease (CVD) patients.
- However, CR participation remains suboptimal in certain patient subgroups.
- Understanding factors influencing CR effectiveness is crucial for optimizing secondary prevention strategies.
Purpose of the Study:
- To examine how sex, age, socioeconomic status, CVD diagnosis, cardiothoracic surgery, and comorbidity affect the association between CR participation and all-cause mortality.
- To evaluate the overall impact of CR on mortality risk in a large cohort of Dutch CVD patients.
Main Methods:
- An observational cohort study involving 83,687 Dutch patients with CVD between 2012 and 2017.
- Cox proportional hazards models and stabilized inverse propensity score weighting were used to analyze the association between CR participation and all-cause mortality.
- Follow-up extended to March 2020, with data analysis conducted from March to May 2020.
Main Results:
- Only 31.3% of eligible CVD patients participated in CR, with significant variations across subgroups.
- CR participation was associated with a 32% reduced risk of all-cause mortality (adjusted hazard ratio, 0.68).
- The mortality risk reduction from CR was independent of sex, age, socioeconomic status, and comorbidity, but varied significantly by CVD diagnosis and cardiothoracic surgery status.
Conclusions:
- CR participation is linked to a substantial 32% reduction in all-cause mortality among CVD patients.
- The benefits of CR are broadly applicable across diverse patient demographics and health statuses.
- Findings support wider prescription of CR, particularly for vulnerable CVD patient groups, to enhance secondary prevention efforts.
Importance:
Cardiac rehabilitation (CR) is an effective strategy to improve clinical outcomes, but it remains underused in some subgroups of patients with cardiovascular disease (CVD).
Objective:
To investigate the implications of sex, age, socioeconomic status, CVD diagnosis, cardiothoracic surgery, and comorbidity for the association between CR participation and all-cause mortality.
Design, Setting, And Participants:
Observational cohort study with patient enrollment between July 1, 2012, and December 31, 2017, and a follow-up to March 19, 2020. The dates of analysis were March to May 2020. This study was performed among Dutch patients with CVD with a multidisciplinary outpatient CR program indication and who were insured at Coöperatie Volksgezondheidszorg, one of the largest health insurance companies in the Netherlands. Among 4.1 million beneficiaries, patients with CVD with an acute coronary event (myocardial infarction or unstable angina pectoris), stable angina pectoris, chronic heart failure, or cardiothoracic surgery (coronary artery bypass grafting, valve replacement, or percutaneous coronary intervention) were identified by inpatient diagnosis codes and included in the study.
Main Outcomes And Measures:
Cox proportional hazards models were used to evaluate the association between CR participation and all-cause mortality. Stabilized inverse propensity score weighting was used to account for patient and disease characteristics associated with CR participation.
Results:
Among 83 687 eligible patients with CVD (mean [SD] age, 67 [12] years; 60.4% [n = 50 512] men), only 31.3% (n = 26 171) participated in CR, with large variation across different subgroups (range, 5.1%-73.0%). During a mean (SD) of 4.7 (1.8) years of follow-up, 1966 CR participants (7.5%) and 13 443 CR nonparticipants (23.4%) died. After multivariable adjustment, CR participation was associated with a 32% lower risk of all-cause mortality (adjusted hazard ratio, 0.68; 95% CI, 0.65-0.71) compared with nonparticipation. Sex, age, socioeconomic status, and comorbidity did not alter risk reduction after CR participation, but a statistically significant interaction association was found across categories of CVD diagnosis and cardiothoracic surgery. Larger reductions in risk estimates for all-cause mortality were found after CR participation for STEMI (adjusted HR, 0.59; 95% CI, 0.52-0.68 vs 0.72; 95% CI, 0.65-0.79; P < .001), NSTEMI (adjusted HR, 0.64; 95% CI, 0.58-0.70 vs 0.72; 95% CI, 0.65-0.79; P < .001), and stable AP (adjusted HR, 0.69; 95% CI, 0.63-0.76 vs 0.72; 95% CI, 0.65-0.79; P < .001) compared with patients with chronic heart failure, whereas unstable AP had a smaller risk reduction (adjusted HR, 0.75; 95% CI, 0.67-0.85 vs 0.72; 95% CI, 0.65-0.79; P < .001).
Conclusions And Relevance:
In this cohort study, CR participation was associated with a 32% risk reduction in all-cause mortality, and this benefit was independent of sex, age, socioeconomic status, and comorbidity. These findings reinforce the importance of CR participation in secondary prevention and highlight the possibility that CR should be prescribed more widely to vulnerable patients with CVD, such as older adults with chronic diseases or multimorbidity.
