Long-term patient outcomes from a multidisciplinary cardiac rehabilitation programme with integrated nurse specialist support: A retrospective cohort study

Abstract

Background

Cardiac rehabilitation programmes, while demonstrating benefits, face challenges in universal adoption, particularly in New Zealand. This study evaluates the long-term impact of cardiac rehabilitation participation and attendance on survival and readmission rates in the Auckland Health District.

Objective

To examine the impact of patient participation in nurse-led lifestyle rehabilitation and physiotherapy exercise rehabilitation on key outcomes, including all-cause mortality, and all-cause, cardiac-specific, and kidney disease readmission rates.

Design

Retrospective cohort study.

Setting

Auckland Health District, New Zealand.

Participants

3331 patients registered in the Auckland cardiac rehabilitation programme between 2016 and 2020.

Methods

Data analysis included examining associations between attendance at nurse-led lifestyle and physiotherapy-led exercise sessions and outcomes at 12, 24 months, and 2022 year-end, including all-cause mortality, all-cause readmission, and cardiac-specific readmission rates. Analysis methods included survival analysis, Cox proportional regression, and logistic binary regression, controlling for confounders using propensity score weights and baseline factors.

Results

1363 (40.9 %) patients attended at least one lifestyle rehabilitation session (average 5.0 ± 2.9 sessions), 1121 (33.7 %) patients attended at least one exercise rehabilitation session (average 6.8 ± 7.4 sessions), and 649 (19.5 %) patients attended at least one lifestyle and one exercise rehabilitation session. Increased likelihood of participation in rehabilitation was explained by ethnicity, while current and historical tobacco use, history of heart failure, receiving an angiogram, PCI, or other treatment such as medical management or implantable devices were associated with lower odds of participation. Participation in rehabilitation (average 7.9 ± 6.1 sessions) was associated with a higher mean survival estimate (7.6 years vs. 6.4 years, p < 0.001) while Cox proportional hazard regression, controlling for baseline factors and propensity score weights showed that a single session of rehabilitation attended had a 2.1 % decreased risk of mortality (hazard ratio = 0.98, 95 % CI: 0.96 to 0.99, p = 0.29). The cumulative hazard ratio for average attendance (7.9 ± 6.1 sessions) was 0.85 (95 % CI: 0.83 to 0.86, p < 0.001) indicating a 15 % decreased risk of mortality during follow-up. 20 % lower kidney disease readmission rates were observed among participants over the next 24 months (p < 0.05). However, no differences in all-cause or cardiac-specific readmission rates were observed.

Conclusions

The study supports the effectiveness of cardiac rehabilitation in improving long-term survival for Auckland Health District patients. The positive impact of nurse-led interventions and integrated support throughout the cardiac rehabilitation process highlights the need for translating this model to other health districts in New Zealand to optimise patient care and outcomes.