Department of Emergency Medicine, School of Medicine (Dr Bush), Department of Epidemiology, Gillings School of Global Public Health (Drs Bush, Kucharska-Newton, Stürmer, and Brookhart), Division of Cardiology, School of Medicine (Dr Simpson), and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy (Dr Fang), University of North Carolina, Chapel Hill; and Department of Epidemiology, College of Public Health, University of Kentucky, Lexington (Dr Kucharska-Newton).
J Cardiopulm Rehabil Prev. 2020 Mar;40(2):87-93. doi: 10.1097/HCR.0000000000000452.
Outpatient cardiac rehabilitation (CR) participation after myocardial infarction (MI) reduces all-cause mortality; however, less is known about effects of CR on post-MI hospitalization. The study objective was to investigate effects of CR on hospitalization following acute MI among older adults.
Medicare beneficiaries aged 65 to 88 yr hospitalized in 2008 with acute MI, who survived at least 60 d post-discharge, had a revascularization procedure during index hospitalization, and did not have an MI in previous year were eligible for this study. CR initiation was assessed in the 60 d post-discharge. Competing risk survival analysis was used to estimate the proportion of discharged beneficiaries hospitalized between the end of 60-d exposure window and December 31, 2009, treating death as a competing event.
The mean ± SD age of 32 851 Medicare beneficiaries meeting study criteria was 75 ± 6.0 yr, approximately half were male (52%), and the majority were white (88%). In this study, 21% of beneficiaries initiated CR within the exposure window. At 1 yr post-discharge, CR initiators had a lower risk of recurrent MI (4.2% [95% CI, 3.5-5.1]), cardiovascular (15.7% [95% CI, 14.3-17.2]), and all-cause (30.4% [95% CI, 28.8-32.1]) hospitalization than noninitiators (5.2% [95% CI, 5.0-5.5]; 18.0% [95% CI, 17.6-18.4]; and 33.2% [95% CI, 32.5-33.8], respectively). There was no difference in fracture risk (negative control outcome).
This study provides evidence that CR can reduce the 1-yr risk of cardiovascular and all-cause hospital admissions in Medicare aged MI survivors.
心肌梗死后（MI）门诊心脏康复（CR）的参与可降低全因死亡率；然而，关于 CR 对 MI 后住院的影响知之甚少。本研究的目的是探讨 CR 对老年急性 MI 患者住院的影响。
本研究纳入了 2008 年住院并接受急性 MI 治疗、出院后至少存活 60 天、在住院期间进行了血运重建手术且前一年无 MI 的年龄在 65 至 88 岁之间的 Medicare 受益人的数据。在出院后 60 天内评估 CR 的开始情况。采用竞争风险生存分析来估计在 60 天暴露窗口结束至 2009 年 12 月 31 日之间出院受益人的住院比例，将死亡视为竞争事件。
符合研究标准的 32851 名 Medicare 受益人的平均年龄（SD）为 75（6.0）岁，约有一半（52%）为男性，大多数（88%）为白人。在本研究中，有 21%的受益人在暴露窗口内开始接受 CR。出院后 1 年，CR 启动者再发 MI（4.2%[95%CI，3.5-5.1]）、心血管（15.7%[95%CI，14.3-17.2]）和全因（30.4%[95%CI，28.8-32.1]）住院的风险低于未启动者（5.2%[95%CI，5.0-5.5]；18.0%[95%CI，17.6-18.4]；33.2%[95%CI，32.5-33.8]）。骨折风险（阴性对照结果）无差异。
本研究提供了证据表明，CR 可以降低 Medicare 年龄 MI 幸存者 1 年内心血管和全因住院的风险。
