Two-year prognosis and cardiovascular disease prevention after acute coronary syndrome: the role of cardiac rehabilitation-a French nationwide study

Aims To evaluate the impact of cardiac rehabilitation (CR) on optimization of secondary prevention treatments for acute coronary syndrome (ACS), medication persistence, medical follow-up, rehospitalization, and all-cause mortality.Methods and results The National Health Insurance database was used to identify all patients hospitalized for ACS in France in 2019 and those among them who received CR. Patients' characteristics and outcomes were described and compared between CR and non-CR patients. Poisson regression models were used to identify the impact of CR after adjusting for confounders. A Cox model was fitted to identify the variables related to mortality after adjustment for medication persistence and cardiologic follow-up. In 2019, 22% of 134 846 patients hospitalized for ACS in France received CR within 6 months of their discharge. After 1 year, only 60% of patients who did not receive CR were still taking BASI (combination of beta-blockers, antiplatelet agents, statins, and renin-angiotensin-aldosterone system inhibitors) drugs. This rate and the medical follow-up rate were higher in patients who received CR. Two years after the ACS event, patients who received CR had better medical follow-up and lower mortality risk, after adjusting for cofounding variables [adjusted hazard ratio all-cause mortality = 0.65 (0.61-0.69)]. After adjustment for the dispensing of cardiovascular drugs and cardiologic follow-up, the independent effect of CR was not as strong but remained significant [hazard ratio = 0.90 (95% confidence interval: 0.84-0.95)].Conclusion Patients who received CR after hospitalization for ACS had a better prognosis. Optimization of efficient secondary prevention strategies, improved medication persistence, and enhanced cardiologic follow-up seemed to play a major role. In our nationwide study of all patients hospitalized for acute coronary syndrome (ACS) in 2019 (n = 134 846), 22% were admitted in cardiac rehabilitation (CR) after their hospitalization. The admission in CR unit increased patients' medication persistence, increased the chance to initiate a tobacco replacement therapy in smokers, and reduced rehospitalization risk and the recurrence of ACS. In addition, the risk of death was reduced in the 2 years following the hospitalization. Health benefits associated with an admission in CR following an ACS are significant focusing recurrence and mortality. The correction of cardiovascular risk factors, the improvement of medication persistence, and a more frequent cardiologic follow-up play a major role in these health benefits.These results should help to encourage increased referral for and patient participation in CR programmes, whose rate is still very low in many countries, including France. Finally, decreasing hospital capacity means that new rehabilitation modalities need to be considered, including supervised home-based CR and tele-rehabilitation. Graphical Abstract