The Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Lidingövägen 1, P. O. Box 5626, 114 86 Stockholm, Sweden.
Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden.
Eur J Prev Cardiol. 2022 Mar 25;29(3):485-492. doi: 10.1093/eurjpc/zwab083.
Participation in exercise-based cardiac rehabilitation (exCR) increases aerobic capacity and improves outcomes in patients following myocardial infarction (MI) and is therefore universally recommended. While meta-analyses consistently report that participation in exCR reduces cardiovascular mortality, there are conflicting results regarding effects on total mortality. Presently, many eligible patients do not receive exCR in clinical practice. We aimed to investigate the relation between participation in exCR post-MI and total mortality in men and women in a nationwide real-world cohort from the SWEDEHEART registry.
Longitudinal, observational cohort study.
In total, 20 895 patients from the SWEDEHEART registry were included. Mortality data were obtained from the Swedish National Population Registry. During a mean of 4.55 (±2.33) years of follow-up, 1000 patients died. Using Cox regression for proportional odds and taking a wide range of potential confounders into consideration, participation in exCR was related to significantly lower total mortality [hazard ratio (HR) 0.72, 95% confidence interval 0.62-0.83]. Excluding patients with shorter follow-up than 2 years did not alter the results. Exercise-based CR participation was related to lowered total mortality in most of the investigated subgroups. The risk reduction was more pronounced in women than in men (HR 0.54 vs. 0.81, respectively).
Participation in exCR was associated with reduced total mortality, and more pronounced in women, compared with men. Our results further support the recommendations to participate in exCR, and hence we argue that exCR should be a mandatory part of comprehensive CR programmes, offered to all patients post-MI.
参与基于运动的心脏康复（exCR）可提高心肌梗死后患者的有氧运动能力并改善其预后，因此被广泛推荐。尽管荟萃分析一致报告，参与 exCR 可降低心血管死亡率，但关于其对总死亡率的影响存在矛盾的结果。目前，许多符合条件的患者在临床实践中并未接受 exCR。我们旨在调查 SWEDEHEART 注册中心的全国真实世界队列中，MI 后参与 exCR 与总死亡率之间的关系。
纵向观察性队列研究。
共纳入来自 SWEDEHEART 注册中心的 20895 例患者。死亡率数据来自瑞典国家人口登记处。在平均 4.55（±2.33）年的随访期间，有 1000 例患者死亡。使用 Cox 回归进行比例优势分析，并考虑了广泛的潜在混杂因素，结果表明，参与 exCR 与总死亡率显著降低相关[风险比（HR）0.72，95%置信区间 0.62-0.83]。排除随访时间短于 2 年的患者并不会改变结果。在大多数研究的亚组中，exCR 参与与降低总死亡率相关。女性的风险降低程度比男性更明显（HR 分别为 0.54 和 0.81）。
与男性相比，女性参与 exCR 与总死亡率降低相关，且降低幅度更大。我们的结果进一步支持了参与 exCR 的建议，因此我们认为 exCR 应该是 MI 后综合 CR 计划的强制性组成部分，应提供给所有患者。
