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

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

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.

• Jezik: Angleški jezik
• Ključne besede: 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
• Vrsta gradiva: Članek v reviji
• Tipologija: 1.01 - Izvirni znanstveni članek
• Organizacija: EF - Ekonomska fakulteta
• Status publikacije: Objavljeno
• Različica publikacije: Objavljena publikacija
• Leto izida: 2025
• Št. strani: Str. 1-18
• Številčenje: Vol. 20, issue 1
• PID: 20.500.12556/RUL-174186
• UDK: 616.1
• ISSN pri članku: 2211-8179
• DOI: 10.5334/gh.1470
• COBISS.SI-ID: 248823811
• Datum objave v RUL: 03.10.2025

Licence

• Licenca: CC BY 4.0, Creative Commons Priznanje avtorstva 4.0 Mednarodna
• Povezava: http://creativecommons.org/licenses/by/4.0/deed.sl
• Opis: To je standardna licenca Creative Commons, ki daje uporabnikom največ možnosti za nadaljnjo uporabo dela, pri čemer morajo navesti avtorja.

Sekundarni jezik

• Jezik: Slovenski jezik
• Ključne besede: zdravstvo, bolezni, sanacija, družbeni stroški