Advanced

Attending Heart School and long-term outcome after myocardial infarction : A decennial SWEDEHEART registry study

Wallert, John ; Olsson, Erik M.G. ; Pingel, Ronnie ; Norlund, Fredrika ; Leosdottir, Margret LU ; Burell, Gunilla and Held, Claes (2019) In European Journal of Preventive Cardiology
Abstract

Background: The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking. Aims: Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction. Methods: Patients with first-time myocardial infarction (<75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006–2015), with >99% complete follow-up in the Causes... (More)

Background: The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking. Aims: Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction. Methods: Patients with first-time myocardial infarction (<75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006–2015), with >99% complete follow-up in the Causes of Death registry for outcome events. Of 192,059 myocardial infarction admissions, 47,907 unique patients with first-time myocardial infarction surviving to the first cardiac rehabilitation visit constituted the study population. The exposure was attending Heart School at the first cardiac rehabilitation visit 6–10 weeks post-myocardial infarction. Data on socioeconomic status was acquired from Statistics Sweden. After multiple imputation, propensity score matching was performed. The association of exposure with mortality was estimated with Cox regression and survival curves. Results: After matching, attending Heart School was associated (hazard ratio (95% confidence interval)) with a markedly lower risk of both all-cause (two-year hazard ratio = 0.53 (0.44–0.64); five-year hazard ratio = 0.62 (0.55–0.69)) and cardiovascular (0.50 (0.38–0.65); 0.57 (0.47–0.69)) mortality. The results were robust in several sensitivity analyses. Conclusions: Attending Heart School during cardiac rehabilitation is associated with almost halved all-cause and cardiovascular mortality after first-time myocardial infarction. The result warrants further investigation through adequately powered randomised trials.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
cardiac rehabilitation, cardiovascular disease, Patient education, prognosis, secondary prevention
in
European Journal of Preventive Cardiology
publisher
SAGE Publications Ltd STM
external identifiers
  • scopus:85073953457
  • pmid:31514507
ISSN
2047-4873
DOI
10.1177/2047487319871714
language
English
LU publication?
yes
id
77dda083-a3b7-437e-89c2-50ef4a7dde53
date added to LUP
2019-11-07 09:56:36
date last changed
2019-11-25 09:35:35
@article{77dda083-a3b7-437e-89c2-50ef4a7dde53,
  abstract     = {<p>Background: The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking. Aims: Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction. Methods: Patients with first-time myocardial infarction (&lt;75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006–2015), with &gt;99% complete follow-up in the Causes of Death registry for outcome events. Of 192,059 myocardial infarction admissions, 47,907 unique patients with first-time myocardial infarction surviving to the first cardiac rehabilitation visit constituted the study population. The exposure was attending Heart School at the first cardiac rehabilitation visit 6–10 weeks post-myocardial infarction. Data on socioeconomic status was acquired from Statistics Sweden. After multiple imputation, propensity score matching was performed. The association of exposure with mortality was estimated with Cox regression and survival curves. Results: After matching, attending Heart School was associated (hazard ratio (95% confidence interval)) with a markedly lower risk of both all-cause (two-year hazard ratio = 0.53 (0.44–0.64); five-year hazard ratio = 0.62 (0.55–0.69)) and cardiovascular (0.50 (0.38–0.65); 0.57 (0.47–0.69)) mortality. The results were robust in several sensitivity analyses. Conclusions: Attending Heart School during cardiac rehabilitation is associated with almost halved all-cause and cardiovascular mortality after first-time myocardial infarction. The result warrants further investigation through adequately powered randomised trials.</p>},
  author       = {Wallert, John and Olsson, Erik M.G. and Pingel, Ronnie and Norlund, Fredrika and Leosdottir, Margret and Burell, Gunilla and Held, Claes},
  issn         = {2047-4873},
  language     = {eng},
  month        = {09},
  publisher    = {SAGE Publications Ltd STM},
  series       = {European Journal of Preventive Cardiology},
  title        = {Attending Heart School and long-term outcome after myocardial infarction : A decennial SWEDEHEART registry study},
  url          = {http://dx.doi.org/10.1177/2047487319871714},
  doi          = {10.1177/2047487319871714},
  year         = {2019},
}