Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study

Shyh Ming Chen; Lin Yi Wang; Mei Yun Liaw; Ming Kung Wu; Po Jui Wu; Chin Ling Wei; An Ni Chen; Tsui Ling Su; Jui Kun Chang; Tsung Hsun Yang; Ching Chen; Cheng I. Cheng; Po Cheng Chen; Yung Lung Chen

doi:10.3389/fcvm.2022.763217

Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study

Shyh Ming Chen^*
, Lin Yi Wang
, Mei Yun Liaw
, Ming Kung Wu
, Po Jui Wu
, Chin Ling Wei
, An Ni Chen
, Tsui Ling Su
, Jui Kun Chang
, Tsung Hsun Yang
, Ching Chen
, Cheng I. Cheng
, Po Cheng Chen
, Yung Lung Chen^*

^*Corresponding author for this work

Research output: Contribution to journal › Journal Article › peer-review

7 Scopus citations

Abstract

Background: Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. Methods: In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. Results: Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308–0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). Conclusions: Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation.

Original language	English
Article number	763217
Journal	Frontiers in Cardiovascular Medicine
Volume	9
DOIs	https://doi.org/10.3389/fcvm.2022.763217
State	Published - 12 04 2022
Externally published	Yes

Bibliographical note

Publisher Copyright:
Copyright © 2022 Chen, Wang, Liaw, Wu, Wu, Wei, Chen, Su, Chang, Yang, Chen, Cheng, Chen and Chen.

Keywords

cardiac rehabilitation
heart failure
mortality
multidisciplinary program
renin-angiotensin-aldosterone system

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10.3389/fcvm.2022.763217

Cite this

Chen, S. M., Wang, L. Y., Liaw, M. Y., Wu, M. K., Wu, P. J., Wei, C. L., Chen, A. N., Su, T. L., Chang, J. K., Yang, T. H., Chen, C., Cheng, C. I., Chen, P. C., & Chen, Y. L. (2022). Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study. Frontiers in Cardiovascular Medicine, 9, Article 763217. https://doi.org/10.3389/fcvm.2022.763217

@article{a18d885ba32a419db9952062ed326a17,

title = "Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study",

abstract = "Background: Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. Methods: In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. Results: Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9\% and the HF rehospitalization rate was 34.6\% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95\% confidence interval [CI]: 0.308–0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). Conclusions: Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation.",

keywords = "cardiac rehabilitation, heart failure, mortality, multidisciplinary program, renin-angiotensin-aldosterone system",

author = "Chen, \{Shyh Ming\} and Wang, \{Lin Yi\} and Liaw, \{Mei Yun\} and Wu, \{Ming Kung\} and Wu, \{Po Jui\} and Wei, \{Chin Ling\} and Chen, \{An Ni\} and Su, \{Tsui Ling\} and Chang, \{Jui Kun\} and Yang, \{Tsung Hsun\} and Ching Chen and Cheng, \{Cheng I.\} and Chen, \{Po Cheng\} and Chen, \{Yung Lung\}",

note = "Publisher Copyright: Copyright {\textcopyright} 2022 Chen, Wang, Liaw, Wu, Wu, Wei, Chen, Su, Chang, Yang, Chen, Cheng, Chen and Chen.",

year = "2022",

month = apr,

day = "12",

doi = "10.3389/fcvm.2022.763217",

language = "英语",

volume = "9",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media SA",

}

Chen, SM, Wang, LY, Liaw, MY, Wu, MK, Wu, PJ, Wei, CL, Chen, AN, Su, TL, Chang, JK, Yang, TH, Chen, C, Cheng, CI, Chen, PC & Chen, YL 2022, 'Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study', Frontiers in Cardiovascular Medicine, vol. 9, 763217. https://doi.org/10.3389/fcvm.2022.763217

TY - JOUR

T1 - Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study

AU - Chen, Shyh Ming

AU - Wang, Lin Yi

AU - Liaw, Mei Yun

AU - Wu, Ming Kung

AU - Wu, Po Jui

AU - Wei, Chin Ling

AU - Chen, An Ni

AU - Su, Tsui Ling

AU - Chang, Jui Kun

AU - Yang, Tsung Hsun

AU - Chen, Ching

AU - Cheng, Cheng I.

AU - Chen, Po Cheng

AU - Chen, Yung Lung

PY - 2022/4/12

Y1 - 2022/4/12

N2 - Background: Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. Methods: In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. Results: Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308–0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). Conclusions: Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation.

AB - Background: Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. Methods: In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. Results: Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308–0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). Conclusions: Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation.

KW - cardiac rehabilitation

KW - heart failure

KW - mortality

KW - multidisciplinary program

KW - renin-angiotensin-aldosterone system

UR - https://www.scopus.com/pages/publications/85138531737

U2 - 10.3389/fcvm.2022.763217

DO - 10.3389/fcvm.2022.763217

M3 - 文章

AN - SCOPUS:85138531737

SN - 2297-055X

VL - 9

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 763217

ER -

Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study

Abstract

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