Effect of Initiating Cardiac Rehabilitation after Myocardial Infarction on Subsequent Hospitalization in Older Adults

Montika Bush, Anna Kucharska-Newton, Ross J. Simpson, Gang Fang, Til Stürmer, M. Alan Brookhart

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: Outpatient cardiac rehabilitation (CR) participation after myocardial infarction (MI) reduces all-cause mortality; however, less is known about effects of CR on post-MI hospitalization. The study objective was to investigate effects of CR on hospitalization following acute MI among older adults. Methods: Medicare beneficiaries aged 65 to 88 yr hospitalized in 2008 with acute MI, who survived at least 60 d post-discharge, had a revascularization procedure during index hospitalization, and did not have an MI in previous year were eligible for this study. CR initiation was assessed in the 60 d post-discharge. Competing risk survival analysis was used to estimate the proportion of discharged beneficiaries hospitalized between the end of 60-d exposure window and December 31, 2009, treating death as a competing event. Results: The mean ± SD age of 32 851 Medicare beneficiaries meeting study criteria was 75 ± 6.0 yr, approximately half were male (52%), and the majority were white (88%). In this study, 21% of beneficiaries initiated CR within the exposure window. At 1 yr post-discharge, CR initiators had a lower risk of recurrent MI (4.2% [95% CI, 3.5-5.1]), cardiovascular (15.7% [95% CI, 14.3-17.2]), and all-cause (30.4% [95% CI, 28.8-32.1]) hospitalization than noninitiators (5.2% [95% CI, 5.0-5.5]; 18.0% [95% CI, 17.6-18.4]; and 33.2% [95% CI, 32.5-33.8], respectively). There was no difference in fracture risk (negative control outcome). Conclusions: This study provides evidence that CR can reduce the 1-yr risk of cardiovascular and all-cause hospital admissions in Medicare aged MI survivors.

Original languageEnglish
Pages (from-to)87-93
Number of pages7
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number2
StatePublished - Mar 1 2020

Bibliographical note

Funding Information:
Dr Stürmer receives investigator-initiated research funding and support as Principal Investigator (R01 AG056479) from the National Institute on Aging and as coinvestigator (R01 HL118255, R01 MD011680) from the National Institutes of Health (NIH). He also receives salary support as Director of Comparative Effectiveness Research (CER), NC TraCS Institute, UNC Clinical and Translational Science Award (UL1TR002489), the Center for Pharmacoepidemiology (current members: GlaxoSmithKline, UCB BioSciences, Merck, Takeda), from pharmaceutical companies (GSK, Amgen, AstraZeneca, Novo Nordisk), and from a generous contribution from Dr Nancy A. Dreyer to the Department of Epidemiology, University of North Carolina at Chapel Hill. Dr Stürmer does not accept personal compensation of any kind from any pharmaceutical company. He owns stock in Novartis, Roche, BASF, AstraZeneca, and Novo Nordisk. Dr Brookhart has received investigator-initiated research funding and support as Principal Investigator (NIH, R21 HD080214, R01 AG023178, R01 AG056479); as co-Investigator from the Agency for Healthcare Research, Patient Centered Outcomes Research Institute, AstraZeneca, and Amgen; honoraria paid via UNC for scientific advisory from Merck, GSK, Pfizer, and World Health Information Consultants; and consulting fees from RxAnte. The other authors declare no conflicts of interest.

Funding Information:
Sources of funding: A National Service Research Award pre-doctoral traineeship from the Agency for Health Care Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, grant no. 5T32 S000032 (Dr Bush).

Publisher Copyright:
© 2020 Wolters Kluwer Health, Inc. All rights reserved.


  • Medicare
  • cardiac rehabilitation
  • competing risk analysis

ASJC Scopus subject areas

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Effect of Initiating Cardiac Rehabilitation after Myocardial Infarction on Subsequent Hospitalization in Older Adults'. Together they form a unique fingerprint.

Cite this