Arwa Younis1,2, Ella Shaviv1,2, Eyal Nof1,2, Ariel Israel1,2, Anat Berkovitch1,2, Ilan Goldenberg1,2,3, Michael Glikson1,4, Robert Klempfner1,2, Roy Beinart1,2,5. 1. The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Heart Research Program, University of Rochester, Rochester, New York. 4. Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel. 5. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Limburg, the Netherlands.
Abstract
BACKGROUND: Atrial fibrillation (AF) is associated with diminished cardiac function, and exercise tolerance. HYPOTHESIS: We sought to investigate the role of cardiac rehabilitation program (CR) in patients with AF. METHODS: The study included 2165 consecutive patients that participated in our CR program between the years 2009 to 2015. All were evaluated by a standard exercise stress test (EST) at baseline, and upon completion of at least 3 months of training. Participants were dichotomized according to baseline fitness and the degree of functional improvement. The combined primary end point was cardiac related hospitalization or all-cause mortality. RESULTS: A total of 292 patients had history of AF, with a mean age of 68 ± 9 years old, 76% of which were males. The median predicted baseline fitness of AF patients was significantly lower compared to non-AF patients (103% vs 122%, P < 0.001, respectively). Prominent improvement was achieved in the majority of the patients in both groups (64% among AF patients and 63% among those without AF). Median improvement in fitness between stress tests was significantly higher in patients with AF (124% vs 110%, P < 0.001, respectively). Among AF patients, high baseline fitness was associated with a lower event rates (HR 0.40; 95%CI 0.23-0.70; P = 0.001). Moreover, prominent improvement during CR showed a protective effect (HR 0.83; 95% CI 0.69-0.99; P = 0.04). CONCLUSION: In patients with AF participating in CR program, low fitness levels at baseline EST are associated with increased risk of total mortality or cardiovascular hospitalization during long-term follow-up. Improvement on follow-up EST diminishes the risk.
BACKGROUND:Atrial fibrillation (AF) is associated with diminished cardiac function, and exercise tolerance. HYPOTHESIS: We sought to investigate the role of cardiac rehabilitation program (CR) in patients with AF. METHODS: The study included 2165 consecutive patients that participated in our CR program between the years 2009 to 2015. All were evaluated by a standard exercise stress test (EST) at baseline, and upon completion of at least 3 months of training. Participants were dichotomized according to baseline fitness and the degree of functional improvement. The combined primary end point was cardiac related hospitalization or all-cause mortality. RESULTS: A total of 292 patients had history of AF, with a mean age of 68 ± 9 years old, 76% of which were males. The median predicted baseline fitness of AFpatients was significantly lower compared to non-AFpatients (103% vs 122%, P < 0.001, respectively). Prominent improvement was achieved in the majority of the patients in both groups (64% among AFpatients and 63% among those without AF). Median improvement in fitness between stress tests was significantly higher in patients with AF (124% vs 110%, P < 0.001, respectively). Among AFpatients, high baseline fitness was associated with a lower event rates (HR 0.40; 95%CI 0.23-0.70; P = 0.001). Moreover, prominent improvement during CR showed a protective effect (HR 0.83; 95% CI 0.69-0.99; P = 0.04). CONCLUSION: In patients with AF participating in CR program, low fitness levels at baseline EST are associated with increased risk of total mortality or cardiovascular hospitalization during long-term follow-up. Improvement on follow-up EST diminishes the risk.
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