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Cardiac rehabilitation is associated with improved long-term outcomes after coronary artery bypass grafting

While cardiac rehabilitation (CR) has proven short and mid-term benefit in coronary artery disease, its long-term benefits in coronary artery bypass grafting (CABG) patients is less certain. Our objective was to examine the late outcomes of patients who attended CR within the first year after CABG.

Adult CABG patients referred to Toronto Rehabilitation Institute (CR group: referred-attended at least 1 session and No-CR group: referred but no attendance), between January 1996 - September 2008 were identified through linkages with clinical and provincial administrative databases for co-morbidities and outcome ascertainment. The primary outcome was a composite of all-cause mortality, acute myocardial infarction, stroke or repeat revascularization (MACCE). The secondary outcome was all-cause mortality. Multivariable Cox proportional hazard models assessed the CR treatment effect adjusting for baseline characteristics.

The study cohort consisted of 5,000 patients, 3,685 (73.7%) in the CR group and 1,315 (26.3%) in the No-CR group. Median referral time was 32.5 days and follow-up was 13.1 years. The CR group were younger (62.6±9.6 vs 64.0±10.5 years), were more likely male (85.0% vs 79.5%) and had less cardiac comorbidities. In adjusted analyses, CR group was associated with decreased MACCE (hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.75-0.91, p<0.0001) and a higher adjusted survival at 15 years (66.3%, vs. 60.1%, HR 0.76, 95% CI 0.68-0.84, p<0.0001) as compared to the No-CR group.

There was a reduction in MACCE and late mortality associated with CR attendance, highlighting the importance of patient referral and participation in CR after CABG.