Referral for cardiac rehabilitation after acute myocardial infarction: Insights from nationwide AMIS Plus registry 2005–2017
Matthias Hermanna b c✉, Fabienne Witassekd, Paul Ernéd, Dragana Radovanovićd, Hans Ricklie
- aCardiology, Zürcher RehaZentrum Wald, Switzerland
- bUniversity Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland. Electronic address: matthias.hermann@zhreha.ch
- cUniversity Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland
- dAMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- eDepartment of Cardiology, Kantonsspital St. Gallen, Switzerland
- ✉
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Abstract
BACKGROUND Referral rates for cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) are low despite a Class I recommendation in the present guidelines. Therefore, we aimed to identify predictors for referral and patient characteristics from the national Swiss AMIS Plus registry. DESIGN AND METHODS Data were extracted from the Swiss AMIS Plus registry between 2005 and 2017, which included patients with ST-elevation myocardial infarction (STEMI) and Non-ST-elevation myocardial infarction (NSTEMI). For 32,416 patient (93.2%) data about destination at discharge were available with 10,940 (33.7%) having a recommendation for CR while 12,282 (37.9%) went home. 9194 (28.4%) were transferred to another hospital after index hospitalisation and were excluded. RESULTS Patients referred to CR were younger (62.6 vs. 68.2 years) and had a higher prevalence of obesity (22.0% vs. 20.4%). Except for smoking (44.0% vs 34.9%), they had less risk factors such as dyslipidemia (55.0% vs. 60.1%), hypertension (55.6% vs. 65.3%) and diabetes (16.7% vs. 21.5%). Patients with in-hospital complications were more likely being referred for CR. Furthermore, STEMI (OR 1.61; CI 1.52-1.71), performed PCI (OR 2.65; CI 2.42-2.90) and Killip class >2 (OR 1.58; CI 1.36-1.84) favoured referral for CR, while age > 65 years, previous myocardial infarction, cerebrovascular disease or peripheral artery disease had a negative impact on referral for CR. CONCLUSIONS Our data from 23,222 patients after AMI demonstrate that in Switzerland patients referred for CR are younger, more obese with more STEMI. In-hospital complications were strong predictors for CR recommendation. Unlike anticipated, other risk factors were less present in CR patients.
TL;DRIt is demonstrated that in Switzerland patients referred for CR are younger, more obese with more STEMI and previous myocardial infarction, cerebrovascular disease or peripheral artery disease had a negative impact on referral for CR. (Semantic Scholar)