Andrea N Devrome1, Sandeep Aggarwal2, M Sean McMurtry3, Danielle Southern4, Trina Hauer5, Brea Lamb5, Ross Arena6, Randy D Moore1, Stephen B Wilton7, James Stone2, Billie-Jean Martin8. 1. Department of Vascular Surgery, University of Calgary, Calgary, Canada. 2. TotalCardiology-Rehabilitation, Calgary, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. 3. Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. 4. Department of Community Health Sciences, University of Calgary, Calgary, Canada. 5. TotalCardiology-Rehabilitation, Calgary, Canada. 6. Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA. 7. Libin Cardiovascular Institute, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada. 8. TotalCardiology-Rehabilitation, Calgary, Canada; Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA. Electronic address: billieje@stanford.edu.
Abstract
BACKGROUND: Peripheral arterial disease (PAD) is common in people referred for cardiac rehabilitation (CR). However, the associations between PAD diagnosis and CR attendance and mortality remain to be defined. METHODS: All patients referred to a 12-week exercise-based CR program were included. Associations between PAD diagnosis and starting CR as well as between PAD diagnosis and completing CR were measured using multivariable logistic regression. Associations between CR completion and mortality were measured using adjusted Cox proportional hazards models, and a propensity-based matching sensitivity analysis was performed. RESULTS: 23,215 patients (mean age 61.3 years; 21.6% female) were referred to CR; 1366 (5.9%) had PAD. Those with PAD were less likely to start CR (57.0% vs 68.2%, adjusted OR 0.81, 95%CI 0.72, 0.91) and complete CR if they started (70.6% vs 76.7%, adjusted OR 0.80, 95%CI 0.68, 0.94). Patients with PAD completing CR had lower exercise capacity at baseline (6.6 vs. 7.6 METs, p < 0.0001) and completion (7.5 vs 8.6 METs, p < 0.0001). There were 3510 deaths over follow-up; 10-year survival was lower in those with PAD (66.9 vs 84.5%; p < 0.0001). CR completion was associated with lower mortality for all (adjusted HR 0.62 (95%CI 0.57, 0.67)), and the magnitude of the association was independent of PAD status. CONCLUSIONS: Patients with PAD referred to CR had a higher mortality than those without, and were less likely to start and complete CR. Completion of CR was associated with improved fitness and survival for PAD patients. These data support broader use of CR by those with PAD.
BACKGROUND:Peripheral arterial disease (PAD) is common in people referred for cardiac rehabilitation (CR). However, the associations between PAD diagnosis and CR attendance and mortality remain to be defined. METHODS: All patients referred to a 12-week exercise-based CR program were included. Associations between PAD diagnosis and starting CR as well as between PAD diagnosis and completing CR were measured using multivariable logistic regression. Associations between CR completion and mortality were measured using adjusted Cox proportional hazards models, and a propensity-based matching sensitivity analysis was performed. RESULTS: 23,215 patients (mean age 61.3 years; 21.6% female) were referred to CR; 1366 (5.9%) had PAD. Those with PAD were less likely to start CR (57.0% vs 68.2%, adjusted OR 0.81, 95%CI 0.72, 0.91) and complete CR if they started (70.6% vs 76.7%, adjusted OR 0.80, 95%CI 0.68, 0.94). Patients with PAD completing CR had lower exercise capacity at baseline (6.6 vs. 7.6 METs, p < 0.0001) and completion (7.5 vs 8.6 METs, p < 0.0001). There were 3510 deaths over follow-up; 10-year survival was lower in those with PAD (66.9 vs 84.5%; p < 0.0001). CR completion was associated with lower mortality for all (adjusted HR 0.62 (95%CI 0.57, 0.67)), and the magnitude of the association was independent of PAD status. CONCLUSIONS:Patients with PAD referred to CR had a higher mortality than those without, and were less likely to start and complete CR. Completion of CR was associated with improved fitness and survival for PAD patients. These data support broader use of CR by those with PAD.
Authors: Eduardo M Vilela; Ricardo Ladeiras-Lopes; Ana Joao; Joana Braga; Susana Torres; Sofia Viamonte; José Ribeiro; Madalena Teixeira; José P Nunes; Ricardo Fontes-Carvalho Journal: World J Cardiol Date: 2021-12-26
Authors: Kasara A Little; Joshua R Smith; Jose R Medina-Inojosa; Audry S Chacin Suarez; Jenna L Taylor; Shane M Hammer; Karen M Fischer; Amanda R Bonikowske; Ray W Squires; Randal J Thomas; Thomas P Olson Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2022-09-02