Prognostic factors influencing all-cause mortality and hospitalizations after inpatient cardiac rehabilitation for acute coronary events

Abstract

Introduction. The comprehensive cardiac rehabilitation (CR) program is essential to improve outcomes. The objective of the study was to identify the prognostic factors for all-cause mortality and hospitalizations during 12 months after inpatient CR for an acute cardiac event and to investigate the impact of a supervised home-based CR program on these outcomes. Material and methods. The study included 449 patients with coronary artery disease who completed the institutional CR program and were divided into 2 groups after discharge: CR(+) group – supervised home-based CR program (186 patients) and CR(-) group – 263 patients who were not supervised. The follow up period was 12 months. Results. The all-cause mortality rate one year after inpatient CR was 5.7%. Prognostic factors for mortality were age, heart failure (HF) NYHA III, HF with reduced ejection fraction (HFrEF), pulmonary congestion at discharge, length of stay in the intensive care unit and CR department. The hospitalization rate was 40.3%. The prognostic factors for hospitalizations were HF NYHA III, HFrEF, N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction, pulmonary congestion at discharge, Charlson comorbidity index and duration of hospitalization in the CR department. In the CR(+) group the mortality (3.22% vs 7.6%, p<0.05) and hospitalization rate (34% vs 48.3%, p<0.01) were lower than in the CR(-) group. Conclusions. In our study, age, HF features, pulmonary congestion at discharge, length of stay in intensive care unit and CR departments were identified as main prognostic factors for all-cause mortality and hospitalizations during one year after institutional CR. The all-cause mortality and hospitalization rate were lower in patients who completed the supervised home-based CR program.