Prof. Paul Dendale ,
Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community Kashish Goel, MBBS; Ryan J. Lennon, MS; R. Thomas Tilbury, MD; Ray W. Squires, PhD Randal J. Thomas, MD, MS CIRCULATIONAHA.110.983536v1
In this retrospective study, the group of Randall Thomas (Mayo clinic Rochester, USA) gives another important proof of the role of cardiac rehabilitation in decreasing mortality in patients after PCI. A large group of patients included in CR after PCI (for acute coronary syndrome or stable angina pectoris) were closely matched with patients who did not participate. The long term outcome (median follow up duration 6,3 years) was significantly different : mortality was reduced by 45-47%, depending on the analysis technique. This result was independent of age, gender, and elective or urgent procedures. The impact on recurrent MI was not significant, but the reduction of the composite endpoint of death, MI, PCI or CABG was also reduced by 40%. Other data in the study were less encouraging : during the study, only 40% of eligible patients did participate in this top level centre, and the number of sessions followed was low (mean of 13,5 sessions/patient) as compared to the standard duration of CR in the States which is around 36 sessions. The effect of CR on the outcome might have been even larger if the drop out could have been reduced, as some recent retrospective database studies have shown. The importance of reimbursement of CR is underscored by the finding that the participation of patients after elective PCI for stable angina in Rochester increased from 25 to 42% since 2006, the moment when Medicare/Medicaid decided to reimburse CR for this indication. So this study is ammunition for those fighting for more inclusions and for reimbursement for CR in PCI patients.
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