부산대학교 도서관

Introduction: Cardiac rehabilitation (CR) reduces hospitalization risk in patients with reduced ejection fraction heart failure (HF). The CR HF mortality impact remains unclear.Methods: We identified Medicare beneficiaries diagnosed with HF between 2014-2017 who were hospitalized with HF diagnosis in 2017. Primary exposure was CR initiation within 180 days of HF hospitalization discharge in 2017; primary outcome was all-cause mortality within 1 year. In full cohort,Cox regression modeled time from discharge to death with time-varying exposure to CR, adjusting for unbalanced characteristics and propensity to initiate CR. We applied propensity score weighting and stratification methods. Using propensity score for CR receipt and survival to the day of CR initiation, we matched 1730 patients who started CR within 180 days to 1730 who did not and modeled survival from CR initiation. We examined association between CR initiation and mortality following CR in a landmark cohort and assessed dose-response relationship between session number and mortality. We conducted sub-group analyses limited to patients with systolic HF ICD code.Results: Of 116,302 HF patients (mean age 82 years, 54% women) admitted at 4,119 hospitals, only 1.5% initiated CR in 6 months. Overall 35% of patients died within 1 year; 10.7% among those who initiated CR within 180 days and 35.2% among those who did not. CR initiation within 180 days was associated with survival benefit in full and landmark cohorts as well as in the propensity-matched analysis hazard ratio [HR]: 0.39, 95% CI: 0.33-0.47; P < 0.001 Among patients who initiated CR within 180 days and survived more than 180 days, completing 3 CR sessions was associated with lower death risk HR: 0.91 95% CI, 0.87- 0.95. In patients with systolic HF, HR: was 0.47, 95% CI 0.41-0.54; P < 0.001.Conclusions: Few patients (1.5%) with HF enrolled in CR within 180 days after hospitalization. CR initiation was associated with reduced 1-year mortality risk.