Open AccessThe role and outcome of cardiac rehabilitation program in patients with atrial fibrillation
Author(s) -
Younis Arwa,
Shaviv Ella,
Nof Eyal,
Israel Ariel,
Berkovitch Anat,
Goldenberg Ilan,
Glikson Michael,
Klempfner Robert,
Beinart Roy
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23001
Subject(s) - medicine , atrial fibrillation , rehabilitation , cardiology , cardiovascular fitness , cardiac function curve , physical therapy , physical fitness , heart failure
Background Atrial fibrillation (AF) is associated with diminished cardiac function, and exercise tolerance. Hypothesis We sought to investigate the role of cardiac rehabilitation program (CR) in patients with AF. Methods The study included 2165 consecutive patients that participated in our CR program between the years 2009 to 2015. All were evaluated by a standard exercise stress test (EST) at baseline, and upon completion of at least 3 months of training. Participants were dichotomized according to baseline fitness and the degree of functional improvement. The combined primary end point was cardiac related hospitalization or all‐cause mortality. Results A total of 292 patients had history of AF, with a mean age of 68 ± 9 years old, 76% of which were males. The median predicted baseline fitness of AF patients was significantly lower compared to non‐AF patients (103% vs 122%, P < 0.001, respectively). Prominent improvement was achieved in the majority of the patients in both groups (64% among AF patients and 63% among those without AF). Median improvement in fitness between stress tests was significantly higher in patients with AF (124% vs 110%, P < 0.001, respectively). Among AF patients, high baseline fitness was associated with a lower event rates (HR 0.40; 95%CI 0.23‐0.70; P = 0.001). Moreover, prominent improvement during CR showed a protective effect (HR 0.83; 95% CI 0.69‐0.99; P = 0.04). Conclusion In patients with AF participating in CR program, low fitness levels at baseline EST are associated with increased risk of total mortality or cardiovascular hospitalization during long‐term follow‐up. Improvement on follow‐up EST diminishes the risk.