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The role of cardiac rehabilitation in patients following acute coronary syndrome in Portugal – are we doing enough?
Session:
Posters (Sessão 6 - Écran 6) - Síndromes Coronárias Agudas e Crónicas
Speaker:
Sofia B. Paula
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.8 Coronary Artery Disease - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Sofia B. Paula; Margarida Figueiredo; Mariana Santos; Mariana Coelho; Samuel Almeida; Lurdes Almeida
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Introduction:</strong> The benefits of cardiac rehabilitation (CR) in patients (P) with acute coronary syndrome (ACS) are well established. In Portugal there are limited centres with CR and P, especially from peripheral hospitals, wait a long time to enter the programme and many of them don’t even enter these programmes. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Purpose: </strong>characterize the P population that go to CR and evaluate short- and long-term outcomes.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods:</strong> Multicenter retrospective study, P with the diagnosis of ACS and data collected from 1/01/2015 to 31/12/2021. P were divided into 2 groups (G). G1 – P with CR programmed and/or planned; G2 – P not referenced for CR. We further analyse P according to MACE events, GA without MACE; GB with MACE. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results: </strong>11992 P were enrolled, only 3162 (26.4%) P were referenced for CR. G1 was younger 63.5 ± 12.4 (p<0.001), had more males 76.7% (p<0.001) and more smokers 38.0% vs 25.3% (p<0.001), but less P with arterial hypertension (AH) 65.1% vs 70.9% (p<0.001), diabetes mellitus (DM) 29.5% vs 32.8% (p<0.001), dyslipidemia 57.0% vs 61.2% (p<0.001), previous heart failure 4.8% vs 7.9% (p<0.001) and chronic kidney disease (CKD) 3.8% vs 7.3% (p<0.001). G1 had although more P with symptoms of angina 29.2% vs 23.3% (p<0.001) and previous MI 20.5% vs 17.6% (p<0.001). Regarding MACE events G1 had better outcomes 1.3% vs 6.1% (p<0.001). Considering MACE events, GB was older 74±12 years (p<0.001), male gender was predominant (62.5%) and had more P with AH 76.9% vs 68.8% (p<0.001), DM 45.1% vs 31.1% (p<0.001), CKD 14.6% vs 5.6% (p<0.001) and pacemaker (PM) or ICD devices 3.8% vs 1.7% (p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Independent predictors of MACE achieved through logistic regression analysis are gender p<0.001, OR 0.325, CI (95%) 0.158-0.672; CKD p= 0.042, OR 4.027, CI 1.019-15.911; time from symptoms to 1<sup>st</sup> contact ≥ 120min p=0.032, OR 2.088, CI 1.067-4.087; usage of inotropic medications p<0.001, OR 6.383, CI 2.995-13.602; left ventricular ejection fraction <30% vs ≥30% p=0.002, OR 4.172, CI 1.722-10.108; need of invasive mechanical ventilation p<0.001, OR 6.593, CI 2.812-15.457 and need of temporary PM p<0.001, OR 12.372, CI 4.025-38.031.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusion</strong>: In these study population P with less cardiovascular (CV) risk factors and comorbidities were more often assigned to CR programmes. Not unpredictable P with more comorbidities suffered more from MACE events. Survival analysis also showed that CV mortality and re-admission at 1 year were higher in P not assigned for CR.</span></span></p>
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