Long-term benefits of the cardiac rehabilitation programme in Girona: a three-year follow-up study

Abstract

Background: Cardiac rehabilitation (CR) is the most effective approach following a cardiovascular event as a secondary preventive strategy. It consists of a multidisciplinary approach to overall cardiovascular risk reduction. Evaluation of the patient’s cardiovascular risk factor profile is a crucial part for the management of CR patients. There is strong evidence about the short-term benefits of CR programmes in the control of the cardiovascular risk factors (CVRF), reducing mortality and improving quality of life. However, the beneficial effect of CR programmes on the risk reduction is not clear longer term. Objective: Our aim was to determine the long-term control of CVRF, after a 3-year follow-up period, in patients referred to the CR programme of Santa Caterina Hospital of Girona, after suffering an acute coronary syndrome (ACS). Methods: A retrospective observational follow-up study was conducted on a cohort of 213 patients (mean age 56 years) referred to the CR programme of Santa Caterina Hospital following ACS, between 2008 and 2013. We evaluated the long-term control of CVRF and the occurrence of major adverse cardiac events (MACE) in a 3-year period of follow-up. The short-term control of CVRF was analysed and the demographic and clinical characteristics of patients were determined. A comparison depending on the length of the CR programme was also performed. Results: Of the 213 patients included, long-term control of low-density lipoprotein cholesterol (LDL-c) blood levels (85.45mg/dL vs 86.27mg/dL, P=0.669) and tobacco consumption (14.85% vs 18.78%, P=0.293) was maintained from post-CR to year three, although both showed a trend towards deterioration. There was a significant increase in systolic blood pressure (BP) (124.58mmHg vs 128.76mmHg, P<0.001), glycosylated haemoglobin (HbA1C) in diabetic patients (6.52% vs 7.10%, P<0.001) and body mass index (BMI) (28.36kg/m2 vs 29.41kg/m2, P<0.001) from post-CR to year three. Short-term CVRF control was significantly improved after discharge from the CR unit for all CVRF analysed. The incidence of MACE at the end of the follow-up was 16.4% and the total death was 2.8%. An extended-length CR programme was reported in 19.25% of the study population. No significant differences in the CVRF control were found between standard-length and extended-length CR programme in all CVRF analysed. Conclusion: The long-term control of CVRF after enrolment in a CR programme has a trend towards deterioration after 3 years of follow-up, which has been significant for systolic BP, HbA1C and BMI. Further studies might be advantageous to confirm our findings