Background: National guidelines recommend CR after CVS. However, neither enrollment in CR nor its benefits have been well described in this population.
Study design: Observational cohort study.
Setting: Enrolled Medicare beneficiaries residing in the United States in 2014.
Synopsis: There were 41,369 Medicare patients who underwent CVS and met the study requirements; of these, 43.2% enrolled in CR programs. Those who had concomitant coronary artery bypass grafting (CABG) surgery or who resided in the Midwest region of the United States were more likely to enroll in CR. Asian, black, and Hispanic patients were less likely to enroll in CR. Enrollment in CR after CVS was associated with a decreased risk of 1-year hospitalization (hazard ratio, 0.66; 95% confidence interval, 0.63-0.69). CR utilization was also associated with a decrease in 1-year mortality after CVS (HR, 0.39; 95% CI, 0.35-0.44).
Enrollment rates in CR after CVS were lower than that of heart transplant patients, but higher than that for patients with systolic heart failure or after CABG. Major study limitations were the lack of generalizability to younger patients because all patients examined were older than 64 years.
Bottom line: Racial and geographic factors influence the rate of enrollment in CR for patients undergoing CVS. All patients should be encouraged to participate in CR after CVS because it is associated with reduced 1-year mortality and risk of hospitalization.
Citation: Patel DK et. al. Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery. JAMA Cardiol. 2019 Oct 23. doi: 10.1001/jamacardio.2019.4032.
Dr. Babbel is a hospitalist and assistant professor of medicine at the University of Utah, Salt Lake City.