Figure 1
Map of comprehensive outpatient cardiac rehabilitation centers (color-coded for timeline of set-up and isochrones representing distance in 15-, 30-, 45- and 60-min driving times).
Figure 2
Flow of participants through analysis.
Figure 3
Interrupted time-series of cardiac rehabilitation (CR) participation rates.
Table 1
Baseline characteristics for non-participants, short-term residential cardiac rehabilitation participants, and comprehensive outpatient cardiac rehabilitation participants.
| CHARACTERISTIC | OVERALL | NO CR | SHORT-TERM | COMPREHENSIVE | p-VALUE |
|---|---|---|---|---|---|
| N = 11815 | N = 7996 | N = 2281 | N = 1538 | ||
| Age | 66 (57–77) | 69 (59–79) | 63 (55–71) | 58 (52–66) | <0.0001 |
| Sex (male) | 7882 (67%) | 5030 (63%) | 1676 (73%) | 1176 (76%) | <0.0001 |
| STEMI | 5431 (46%) | 3112 (39%) | 1410 (62%) | 909 (59%) | <0.0001 |
| Diabetes | 2631 (22%) | 1827 (23%) | 564 (25%) | 240 (16%) | <0.0001 |
| Arterial hypertension | 7245 (61%) | 5030 (63%) | 1384 (61%) | 831 (54%) | <0.0001 |
| Atrial fibrillation | 1481 (13%) | 1147 (14%) | 260 (11%) | 74 (4.8%) | <0.0001 |
| Heart failure | 2094 (18%) | 1366 (17%) | 539 (24%) | 189 (12%) | <0.0001 |
| Depression | 811 (6.9%) | 585 (7.3%) | 147 (6.4%) | 79 (5.1%) | 0.0056 |
| Dementia | 264 (2.2%) | 258 (3.2%) | 5 (0.2%) | 1 (<0.1%) | <0.0001 |
| Malignancy | 358 (3.0%) | 285 (3.6%) | 51 (2.2%) | 22 (1.4%) | <0.0001 |
| Chronic kidney disease | 966 (8.2%) | 768 (9.6%) | 155 (6.8%) | 43 (2.8%) | <0.0001 |
| COPD or asthma | 1038 (8.8%) | 748 (9.4%) | 191 (8.4%) | 99 (6.4%) | 0.0008 |
| Antiplatelet therapy | 11212 (95%) | 7493 (94%) | 2189 (96%) | 1530 (99%) | <0.0001 |
| Lipid-lowering therapy | 9727 (82%) | 6250 (78%) | 2018 (88%) | 1459 (95%) | <0.0001 |
| RAAS inhibitors | 8544 (72%) | 5629 (70%) | 1714 (75%) | 1201 (78%) | <0.0001 |
| β-Blockers | 8834 (75%) | 5682 (71%) | 1871 (82%) | 1281 (83%) | <0.0001 |
| Anti-ischemic therapy | 2381 (20%) | 1660 (21%) | 479 (21%) | 242 (16%) | <0.0001 |
| Revascularization | 10319 (87%) | 6731 (84%) | 2119 (93%) | 1469 (96%) | <0.0001 |
| Number of diagnoses* | 4 (2–5) | 4 (2–5) | 4 (3–6) | 3 (2–4) | <0.0001 |
| Number of procedures* | 15 (9–19) | 13 (7–18) | 16 (10–20) | 17 (13–20) | <0.0001 |
| Length of stay ≥5 days | 6242 (53%) | 4098 (51%) | 1508 (66%) | 636 (41%) | <0.0001 |
| DRG intensity* | 3.4 (2.4–3.8) | 3.2 (2.3–3.8) | 3.4 (2.7–4.2) | 3.6 (3.2–3.8) | <0.0001 |
| University hospital | 6895 (58%) | 4501 (56%) | 1318 (58%) | 1076 (70%) | <0.0001 |
| Hospital with CR center** | 9986 (85%) | 6710 (84%) | 1844 (81%) | 1432 (93%) | <0.0001 |
| Socioeconomic status | <0.0001 | ||||
| High | 2555 (22%) | 1706 (21%) | 410 (18%) | 439 (29%) | |
| Middle-high | 2706 (23%) | 1961 (25%) | 459 (20%) | 286 (19%) | |
| Middle-low | 2545 (22%) | 1761 (22%) | 526 (23%) | 258 (17%) | |
| Low | 4009 (34%) | 2568 (32%) | 886 (39%) | 555 (36%) |
[i] CR, cardiac rehabilitation; STEMI, ST elevation myocardial infarction (vs. non-ST elevation myocardial infarction); COPD, chronic obstructive pulmonary disease; RAAS, renin-angiotensin system inhibitors; CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention.
*DRG – disease-related group; reflecting the intensity of hospital episode, including case mix, diagnoses, procedures, and complications. Total number of coded diagnoses and procedures, capturing all diagnoses and procedures coded during the hospital episode, including diagnoses and procedures not captured by DRG intensity.
**Hospital providing affiliated cardiac rehabilitation center.
Table 2
Baseline characteristics for non-participants, short-term residential cardiac rehabilitation participants, and comprehensive outpatient cardiac rehabilitation participants after weighting.
| OVERALL | NO CR | SHORT-TERM | COMPREHENSIVE | p-VALUE | MAX SMD | KOLMOGOROV–SMIRNOV | |
|---|---|---|---|---|---|---|---|
| N = 4609* | N = 1534* | N = 1537* | N = 1538* | ||||
| Age | 58 (51–66) | 58 (50–67) | 59 (51–66) | 58 (52–66) | 0.66 | 0.0047 | 0.0478 |
| Sex (male) | 76.4% | 76.3% | 76.5% | 76.5% | >0.99 | 0.0012 | 0.0012 |
| STEMI | 59.1% | 59.2% | 59.1% | 59.1% | >0.99 | 0.0010 | 0.0010 |
| Diabetes | 15.6% | 15.6% | 15.6% | 15.6% | >0.99 | 0.0001 | 0.0001 |
| Arterial hypertension | 54.0% | 54.1% | 54.0% | 54.0% | >0.99 | 0.0003 | 0.0003 |
| Atrial fibrillation | 4.8% | 4.8% | 4.8% | 4.8% | >0.99 | 0.0004 | 0.0004 |
| Heart failure | 12.3% | 12.3% | 12.3% | 12.3% | >0.99 | 0.0003 | 0.0003 |
| Depression | 5.1% | 5.2% | 5.1% | 5.1% | >0.99 | 0.0003 | 0.0003 |
| Dementia | 0.1% | 0.1% | 0.1% | 0.1% | >0.99 | 0.0000 | 0.0000 |
| Malignancy | 1.4% | 1.4% | 1.4% | 1.4% | >0.99 | 0.0002 | 0.0002 |
| Chronic kidney disease | 2.8% | 2.8% | 2.8% | 2.8% | >0.99 | 0.0002 | 0.0002 |
| COPD or asthma | 6.4% | 6.5% | 6.4% | 6.4% | >0.99 | 0.0001 | 0.0001 |
| Antiplatelet therapy | 99.5% | 99.5% | 99.5% | 99.5% | 0.95 | 0.0002 | 0.0002 |
| Lipid-lowering therapy | 94.9% | 94.9% | 94.8% | 94.9% | >0.99 | 0.0005 | 0.0005 |
| RAAS inhibitors | 78.1% | 78.1% | 78.1% | 78.1% | >0.99 | 0.0003 | 0.0003 |
| β-Blockers | 83.3% | 83.3% | 83.3% | 83.3% | >0.99 | 0.0001 | 0.0001 |
| Anti-ischemic therapy | 15.7% | 15.7% | 15.7% | 15.7% | >0.99 | 0.0002 | 0.0002 |
| Revascularization | 95.5% | 95.6% | 95.5% | 95.5% | >0.99 | 0.0005 | 0.0005 |
| Number of diagnoses* | 3 (2–4) | 3 (2–4) | 3 (2–4) | 3 (2–4) | 0.14 | 0.0012 | 0.0402 |
| Number of procedures* | 17 (12–20) | 17 (12–20) | 17 (12–20) | 17 (13–20) | 0.79 | 0.0004 | 0.0465 |
| Length of stay ≥5 days | 41.3% | 41.3% | 41.3% | 41.4% | >0.99 | 0.0008 | 0.0008 |
| DRG intensity* | 3.4 (3.0–3.8) | 3.4 (3.0–3.8) | 3.4 (3.0–3.8) | 3.6 (3.2–3.8) | <0.0001 | 0.0047 | 0.1610 |
| University hospital | 70.0% | 70.0% | 70.0% | 70.0% | >0.99 | 0.0003 | 0.0003 |
| Hospital providing CR** | 93.1% | 93.1% | 93.1% | 93.1% | >0.99 | 0.0001 | 0.0001 |
| Socioeconomic status | |||||||
| High | 28.6% | 28.7% | 28.5% | 28.5% | >0.99 | 0.0013 | 0.0013 |
| Middle-High | 18.6% | 18.6% | 18.6% | 18.6% | 0.0015 | 0.0015 | |
| Middle-Low | 16.8% | 16.8% | 16.8% | 16.8% | 0.0004 | 0.0004 | |
| Low | 36.0% | 35.9% | 36.1% | 36.1% | 0.0002 | 0.0002 | |
| Unadjusted sample size | 7996 | 2281 | 1538 | ||||
| Adjusted effective sample size | 3388 | 1208 | 1538 | ||||
| Weighted sample size | 1534 | 1537 | 1538 | ||||
[i] CR, cardiac rehabilitation; STEMI, ST elevation myocardial infarction (vs. non-ST elevation myocardial infarction); COPD, chronic obstructive pulmonary disease; RAAS, renin-angiotensin system inhibitors; CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention.
*DRG – disease-related group; reflecting the intensity of hospital episode, including case mix, diagnoses, procedures, and complications. Total number of coded diagnoses and procedures, capturing all diagnoses and procedures coded during the hospital episode, including diagnoses and procedures not captured by DRG intensity.
**Hospital providing affiliated cardiac rehabilitation center.
Figure 4
Kaplan–Meier freedom from all-cause mortality and cardiovascular hospitalization.