Cardiac rehabilitation and all-causemortality in patients with heart failure: a retrospective cohort study

Buckley, BJR ORCID: 0000-0002-1479-8872, Harrison, SL, Fazio-Eynullayeva, E, Underhill, P, Sankaranarayanan, R, Wright, DJ, Thijssen, DHJ ORCID: 0000-0002-7707-5567 and Lip, GYH (2021) Cardiac rehabilitation and all-causemortality in patients with heart failure: a retrospective cohort study. European Journal of Preventive Cardiology, 28 (15). pp. 1704-1710. ISSN 2047-4873

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Abstract

AIMS: Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF). The aim of this study was therefore to investigate the association of exercise-based CR with all-cause mortality, hospitalisation, stroke, and atrial fibrillation in patients with heart failure. METHODS AND RESULTS: A retrospective cohort study was conducted which utilized a global federated health research network, primarily in the USA. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of CR and/or exercise programmes within 6 months of an HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, comorbidities, medications, and procedures (controls). We ascertained 2-year incidence of all-cause mortality, hospitalization, stroke, and atrial fibrillation. Following propensity score matching, a total of 40 364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality [odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62], 26% lower odds of hospitalization (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to controls, after propensity score matching. The beneficial association of CR and exercise on all-cause mortality was consistent across all subgroups, including patients with HFrEF (0.52, 95% CI 0.48-0.56) and HFpEF (0.65, 95% CI 0.60-0.71). CONCLUSION: Exercise-based CR was associated with lower odds of all-cause mortality, hospitalizations, incident stroke, and incident atrial fibrillation at 2-year follow-up for patients with HF (including patients with HFrEF and HFpEF).

Item Type:	Article
Additional Information:	This is a pre-copyedited, author-produced version of an article accepted for publication in European Journal of Preventive Cardiology following peer review. The version of record Benjamin J R Buckley, Stephanie L Harrison, Elnara Fazio-Eynullayeva, Paula Underhill, Rajiv Sankaranarayanan, David J Wright, Dick H J Thijssen, Gregory Y H Lip, Cardiac rehabilitation and all-cause mortality in patients with heart failure: a retrospective cohort study, European Journal of Preventive Cardiology, Volume 28, Issue 15, December 2021, Pages 1704–1710, is available online at: https://doi.org/10.1093/eurjpc/zwab035
Uncontrolled Keywords:	Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; Cardiac rehabilitation; Heart failure; Exercise; Secondary prevention; Retrospective cohort; EXERCISE CAPACITY; SECONDARY PREVENTION; EUROPEAN ASSOCIATION; POSITION PAPER; PROGRAM; HF; IMPLEMENTATION.; PERFORMANCE; KNOWLEDGE; OUTCOMES; Humans; Atrial Fibrillation; Stroke Volume; Hospitalization; Retrospective Studies; Heart Failure; Cardiac Rehabilitation; Cardiac rehabilitation; Exercise; Heart failure; Retrospective cohort; Secondary prevention; Atrial Fibrillation; Cardiac Rehabilitation; Heart Failure; Hospitalization; Humans; Retrospective Studies; Stroke Volume
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Oxford University Press (OUP)
Date of acceptance:	12 February 2021
Date of first compliant Open Access:	1 August 2022
Date Deposited:	12 May 2022 11:15
Last Modified:	05 Jul 2025 16:15
DOI or ID number:	10.1093/eurjpc/zwab035
URI:	https://researchonline.ljmu.ac.uk/id/eprint/16824

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