| Title: | Uptake and effectiveness of outpatient vs. residential cardiac rehabilitation after myocardial infarction : a nationwide analysis |
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| Authors: | ID Jug, Borut (Author)
ID Fras, Zlatko (Author)
ID Furlan, Tjaša (Author)
ID Novaković, Marko (Author)
ID Tasič, Jerneja (Author)
ID Lainščak, Mitja (Author)
ID Farkaš-Lainščak, Jerneja (Author)
ID Gavrić, Dalibor (Author)
ID Ograjenšek, Irena (Author)
ID Došenović Bonča, Petra (Author) |
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| Files: |  PDF - Presentation file, download (1,89 MB)
MD5: 104C59EFB3E530269C95AB75BCC8A292
 URL - Source URL, visit https://globalheartjournal.com/articles/10.5334/gh.1470
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| Language: | English |
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| Typology: | 1.01 - Original Scientific Article |
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| Organization: |  UKC LJ - Ljubljana University Medical Centre
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| Abstract: | Aims: To estimate the participation in, and the comparative effectiveness of, short-term residential and comprehensive outpatient cardiac rehabilitation (CR), after the latter was introduced in Slovenia by establishing dedicated regional CR centers. Methods: We extracted and analyzed data on all patients hospitalized for myocardial infarction in Slovenia (n = 15,639), focusing on CR participation – either comprehensive outpatient (introduced in 2017) or short-term residential (available throughout the study period 2015–2021). Impact on nation-wide CR participation rates was assessed by interrupted time series analysis; impact on patient-level outcomes (all-cause mortality and cardiovascular hospitalizations) was assessed using Kaplan Meier estimators and ‘doubly robust’ Cox regression with propensity score-derived inverse probability of treatment weighting. Results: Of the 11,815 eligible patients (event-free after 180-day landmark), 3819 (32.3%) attended CR. Nation-wide CR participation rates increased both in level (9.7%, 95% CI 6.3–3.1) and in trend (0.41% per month, 95% CI 0.22–0.60) after outpatient CR was introduced in 2017. After propensity score-based adjustment, participation in either CR was associated with lower event rates (12.8%, 17.2%, and 21.0% at 3-year follow-up for outpatient, residential, and no CR, respectively; p < 0.001). Risk reductions were significant for composite outcomes (outpatient: HR 0.58, 95% CI 0.47–0.70; residential: HR 0.79, 95% CI 0.68–0.93) and all-cause mortality (outpatient: HR 0.56, 95% CI 0.38–0.83; residential: HR 0.59, 95% CI 0.45–0.77), whereas the risk reduction for cardiovascular hospitalizations was only significant for outpatient CR (HR 0.60, 95% CI 0.48–0.74). The incremental cost-effectiveness ratio per life-year gained was €6421 and €7381 for outpatient and residential CR, respectively. Conclusions: Participation in either CR improves outcomes after myocardial infarction, but comprehensive outpatient CR conveys superior risk reductions, primarily through reduced cardiovascular hospitalizations. |
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| Keywords: | health services, diseases, rehabilitation, social costs |
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| Publication status: | Published |
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| Publication version: | Version of Record |
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| Year of publishing: | 2025 |
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| Number of pages: | str. 1-18 |
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| Numbering: | Vol. 20, issue 1 |
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| PID: | 20.500.12556/DiRROS-24560  |
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| UDC: | 616.1 |
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| ISSN on article: | 2211-8179 |
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| DOI: | 10.5334/gh.1470 |
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| COBISS.SI-ID: | 248823811 |
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| Note: | Nasl. z nasl. zaslona;
Opis vira z dne 12. 9. 2025; |
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| Publication date in DiRROS: | 05.12.2025 |
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| Views: | 146 |
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| Downloads: | 56 |
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