Document Detail


Cardiac rehabilitation and survival in older coronary patients.
MedLine Citation:
PMID:  19555836     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study assessed the effects of cardiac rehabilitation (CR) on survival in a large cohort of older coronary patients. BACKGROUND: Randomized controlled trials and meta-analyses have shown that CR improves survival. However, trial participants have been predominantly middle-aged, low- or moderate-risk, white men. METHODS: The population consisted of 601,099 U.S. Medicare beneficiaries who were hospitalized for coronary conditions or cardiac revascularization procedures. One- to 5-year mortality rates were examined in CR users and nonusers using Medicare claims and 3 analytic techniques: propensity-based matching, regression modeling, and instrumental variables. The first method used 70,040 matched pairs, and the other 2 techniques used the entire cohort. RESULTS: Only 12.2% of the cohort used CR, and those users averaged 24 sessions. Each technique showed significantly lower (p < 0.001) 1- to 5-year mortality rates in CR users than nonusers. Five-year mortality relative reductions were 34% in propensity-based matching, 26% from regression modeling, and 21% with instrumental variables. Mortality reductions extended to all demographic and clinical subgroups including patients with acute myocardial infarctions, those receiving revascularization procedures, and those with congestive heart failure. The CR users with 25 or more sessions were 19% relatively less likely to die over 5 years than matched CR users with 24 or fewer sessions (p < 0.001). CONCLUSIONS: Mortality rates were 21% to 34% lower in CR users than nonusers in this socioeconomically and clinically diverse, older population after extensive analyses to control for potential confounding. These results are of similar magnitude to those observed in published randomized controlled trials and meta-analyses in younger, more selected populations.
Authors:
Jose A Suaya; William B Stason; Philip A Ades; Sharon-Lise T Normand; Donald S Shepard
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-26     Completed Date:  2009-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  25-33     Citation Subset:  AIM; IM    
Affiliation:
Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts 02454-9110, USA. suaya@brandeis.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cohort Studies
Coronary Disease / mortality,  rehabilitation*,  surgery
Exercise Therapy
Female
Humans
Male
Myocardial Revascularization / mortality,  rehabilitation*
Regression Analysis
United States / epidemiology
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2009 Jun 30;54(1):34-5   [PMID:  19555837 ]

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