Study Shows Impact of Follow-Up Rehabilitation on PCI Survival Rates

May 16, 2011—The American Heart Association (AHA) announced the publication of a study demonstrating that patients who undergo percutaneous coronary interventions (PCI) are more likely to survive longer if they participate in structured follow-up care. The study by Kashish Goel, MD, et al was published online ahead of print in Circulation.

According to the AHA, the investigators discovered a 46% relative reduction in death from all causes in patients who participated in cardiac rehabilitation after PCI during a 14-year period. Using data from a Mayo Clinic registry of PCI patients, along with telephone follow-up, the investigators examined outcomes for almost 2,400 patients who underwent a first PCI in the Rochester, Minnesota, area from 1994 to 2008, and survived their hospital stay.

The investigators reported that 40% of the patients had participated in at least one session of a cardiac rehabilitation program, and participants attended an average of 13.5 sessions. Such programs can boost survival rates after heart attacks and systematically provide lifestyle interventions and treatments to improve recovery and long-term health of heart patients, the AHA noted.

“Our findings show that patients who participate in cardiac rehabilitation following PCI have better long-term survival—about 50% better—than those who don't participate in cardiac rehabilitation,” commented lead author Randal Thomas, MD, Director of the Mayo Clinic's Cardiovascular Health Clinic in Rochester.

The results accounted for smoking status, obesity, high cholesterol, family history, and certain medical conditions that might affect life expectancy, such as heart failure, kidney disease, or diabetes. The investigators noted a difference in death rates starting at 1-year follow-up. Improved outcomes were among men and women, older and younger patients, and in patients who had undergone elective or nonelective PCI.

Approximately 400 patients had subsequent heart attacks and 755 patients had additional procedures to open blocked vessels. In all, 503 patients died during follow-up; 199 of the deaths were validated as being cardiac-related.

According to Dr. Thomas, although cardiac rehabilitation is recommended in the multisociety 2005 Guideline Update for PCI, only one-quarter of eligible patients in the United States participate. Gains in long-term survival would be substantial if all eligible PCI patients received cardiac rehabilitation.

Dr. Thomas advised that physicians and patients should understand that PCI is an important treatment, but not a cure for heart disease, and that ongoing interventions after PCI can help patients live longer, healthier lives. Cardiac rehabilitation programs include patient education, monitored and personalized exercise training, nutrition counseling, smoking cessation support, weight control therapy, and medical evaluations to track patient progress, symptoms, medication side effects, and medication adherence.

He added, “Cardiac rehabilitation programs are effective at improving recovery, quality of life, and long-term survival because they help deliver the lifestyle and medication therapies that have been shown to slow or even reverse the process of heart disease.”

In the observational study, the investigators used three statistical techniques to account for factors that might bias their results. For example, younger, healthier, more motivated patients who were already more likely to live longer were also more likely to participate in cardiac rehabilitation.

Dr. Thomas noted that although the study population was predominantly white, the results are consistent with other studies of cardiac rehabilitation in other patient subgroups with cardiovascular disease that have included larger groups of nonwhite patients. He stated that the study results should be further validated in other patient populations. Even in the unlikely event that the study results overestimate the true impact of cardiac rehabilitation and such services reduced deaths within 5 years by only 20% to 30% (instead of 46%, as found in the study), its impact on survival would still be substantial for patients after PCI, he said.

According to the AHA, most insurance companies cover up to 36 sessions of cardiac rehabilitation after PCI, heart attack, and some other heart conditions. Medicare, which approved coverage of the programs for PCI patients beginning in 2006, typically covers 80% of the costs. Participation by patients after PCI appears to have increased since the Medicare change in 2006, although Dr. Thomas said many doctors and patients still remain unaware that coverage for cardiac rehabilitation is available after PCI.