Uptake and effectiveness of outpatient vs. residential cardiac rehabilitation after myocardial infarction : a nationwide analysis

Jug, Borut (author), Fras, Zlatko (author), Furlan, Tjaša (author), Novaković, Marko (author), Tasič, Jerneja (author), Lainščak, Mitja (author), Farkaš-Lainščak, Jerneja (author), Gavrić, Dalibor (author), Ograjenšek, Irena (author), Došenović Bonča, Petra (author)

Aims: To estimate the participation in, and the comparative effectiveness of, short-term residential and comprehensive outpatient cardiac rehabilitation (CR), after the latter was introduced in Slovenia by establishing dedicated regional CR centers. Methods: We extracted and analyzed data on all patients hospitalized for myocardial infarction in Slovenia (n = 15,639), focusing on CR participation – either comprehensive outpatient (introduced in 2017) or short-term residential (available throughout the study period 2015–2021). Impact on nation-wide CR participation rates was assessed by interrupted time series analysis; impact on patient-level outcomes (all-cause mortality and cardiovascular hospitalizations) was assessed using Kaplan Meier estimators and ‘doubly robust’ Cox regression with propensity score-derived inverse probability of treatment weighting. Results: Of the 11,815 eligible patients (event-free after 180-day landmark), 3819 (32.3%) attended CR. Nation-wide CR participation rates increased both in level (9.7%, 95% CI 6.3–3.1) and in trend (0.41% per month, 95% CI 0.22–0.60) after outpatient CR was introduced in 2017. After propensity score-based adjustment, participation in either CR was associated with lower event rates (12.8%, 17.2%, and 21.0% at 3-year follow-up for outpatient, residential, and no CR, respectively; p < 0.001). Risk reductions were significant for composite outcomes (outpatient: HR 0.58, 95% CI 0.47–0.70; residential: HR 0.79, 95% CI 0.68–0.93) and all-cause mortality (outpatient: HR 0.56, 95% CI 0.38–0.83; residential: HR 0.59, 95% CI 0.45–0.77), whereas the risk reduction for cardiovascular hospitalizations was only significant for outpatient CR (HR 0.60, 95% CI 0.48–0.74). The incremental cost-effectiveness ratio per life-year gained was €6421 and €7381 for outpatient and residential CR, respectively. Conclusions: Participation in either CR improves outcomes after myocardial infarction, but comprehensive outpatient CR conveys superior risk reductions, primarily through reduced cardiovascular hospitalizations.

• Language: English
• Keywords: health services, diseases, rehabilitation, social costs, center-based cardiac rehabilitation, short-term cardiac rehabilitation, myocardial infarction, comparative effectiveness research, outcomes research, propensity score, cost-effectiveness analysis
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: EF - School of Economics and Business
• Publication status: Published
• Publication version: Version of Record
• Year: 2025
• Number of pages: Str. 1-18
• Numbering: Vol. 20, issue 1
• PID: 20.500.12556/RUL-174186
• UDC: 616.1
• ISSN on article: 2211-8179
• DOI: 10.5334/gh.1470
• COBISS.SI-ID: 248823811
• Publication date in RUL: 03.10.2025

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: zdravstvo, bolezni, sanacija, družbeni stroški