BACKGROUND: Traditional cardiac rehabilitation (CR) improves cardiovascular outcomes and reduces mortality, but less is known about the relative benefit of intensive CR (ICR) which incorporates greater lifestyle education through 72 sessions (versus 36 in CR). Our objective was to determine whether ICR is associated with a mortality and cardiovascular benefit compared with CR. METHODS: Retrospective cohort study of Medicare Fee-For-Service beneficiaries in a 100% sample, claims data set. Qualifying events were captured from May 1, 2016 to December 31, 2019 and ICR/CR utilization captured from May 1, 2016 to December 31, 2020. Among patients attending at least 1 day of either CR or ICR, Cox proportional hazards models using a 1 to 5 propensity score match were used to compare utilization and the association of ICR versus CR participation with (1) all-cause mortality and (2) cardiovascular-related hospitalizations or nonfatal cardiac events. Dose-response was assessed by the number of days attended. RESULTS: From 2016 to 2019, 1 277 358 unique patients met at least one qualifying indication for ICR/CR from 2016 to 2019. Of these, 262 579 (20.6%) and 4452 (0.4%) attended at least one session of CR or ICR, respectively (mean [SD] age, 73.2 [7.8] years; 32.3% female). In the matched sample, including 26 659 total patients (median, 2.4-year follow-up), ICR was associated with 12% lower all-cause mortality (multivariable adjusted hazard ratio, 0.88 [95% CI, 0.78–0.99]; P =0.036) compared with CR but no significant difference for cardiovascular-related hospitalization or nonfatal cardiac events. The mortality benefit was seen for both ICR and CR per day strata, with each modality demonstrating a clear dose-response benefit. CONCLUSIONS: ICR is associated with lower mortality than traditional CR among Medicare beneficiaries but no difference in cardiovascular-related hospitalization or nonfatal cardiac events. Moreover, ICR and CR demonstrate a dose-response relationship for mortality. Additional studies are needed to confirm these observations and to better understand the mechanisms by which ICR may lead to a reduction in mortality.

中文翻译：

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强化与传统心脏康复：2016-2020 年回顾性医疗保险队列中的死亡率和心血管结果

背景：传统的心脏康复 (CR) 可改善心血管结局并降低死亡率，但人们对强化 CR (ICR) 的相对益处知之甚少，该强化 CR (ICR) 通过 72 次课程（相对于 CR 中的 36 次）纳入了更多的生活方式教育。我们的目标是确定与 CR 相比，ICR 是否与死亡率和心血管获益相关。 方法：医疗保险按服务收费受益人的回顾性队列研究，采用 100% 样本、索赔数据集。合格事件的捕获时间为2016年5月1日至2019年12月31日，ICR/CR利用率的捕获时间为2016年5月1日至2020年12月31日。在参加至少1天CR或ICR的患者中，Cox比例风险模型使用使用 1 至 5 倾向评分匹配来比较 ICR 与 CR 参与的利用率以及与 (1) 全因死亡率和 (2) 心血管相关住院或非致命性心脏事件的关联。剂量反应通过就诊天数进行评估。 结果：从 2016 年到 2019 年，1 277 358 名独特患者在 2016 年到 2019 年期间满足了至少一项 ICR/CR 合格指征。其中，262 579 名 (20.6%) 和 4452 名 (0.4%) 参加了至少一次 CR 或 ICR，分别（平均 [SD] 年龄，73.2 [7.8] 岁；32.3% 为女性）。在匹配样本中，包括 26 659 名患者（中位随访 2.4 年），ICR 与全因死亡率降低 12% 相关（多变量调整风险比，0.88 [95% CI，0.78-0.99]；磷=0.036）与 CR 相比，但心血管相关住院或非致命性心脏事件没有显着差异。ICR 和 CR 每日分层均具有死亡率获益，每种方式均显示出明显的剂量反应获益。 结论：在医疗保险受益人中，ICR 与传统 CR 相比死亡率较低，但在心血管相关住院或非致命性心脏事件方面没有差异。此外，ICR 和 CR 证明了死亡率的剂量反应关系。需要更多的研究来证实这些观察结果，并更好地了解 ICR 可能导致死亡率降低的机制。