Among patients who had not undergone rehabilitation, 16.9% died from cardiac causes. These patients were also more likely to develop diabetes (41.3% vs 33.7%; P=.002), arterial hypertension (89.2% vs 85.3%; P= .017), or peripheral arterial occlusive disease (15.3% vs 9.8%; P=.002) than those who had undergone rehabilitation.
Notably, of the 727 patients for whom rehabilitation was approved, 175 did not participate. The study authors believe the main reason for this was likely patients’ own decisions to decline.
This study examined data from the federal state of Saxony-Anhalt in former East Germany, finding a much lower rate of rehabilitation participation among hospitalized CHD patients there (28.9%) than in previous studies of CHD patients elsewhere in Germany (average participation of at least 51%).
Saxony-Anhalt has the highest level of myocardial infarction mortality in Germany at 104 per 100,000 people per year, compared to the lowest level in Bremen at 35 per 100,000 people per year. Saxony-Anhalt is also the federal state with the highest levels of traditional CHD risk factors, such as diabetes, arterial hypertension, obesity, and smoking.
“If one assumes that the low rehabilitation participation rate observed here can be extrapolated to the entire federal state of Saxony-Anhalt, and that rehabilitation participation rates are higher in other states, this may explain why cardiac mortality in Saxony-Anhalt is higher than in Germany as a whole,” the researchers wrote.
These findings suggest that rehabilitation after hospitalization due to heart disease may significantly improve patient outcomes.
Schlitt A, Wischmann P, Wienke A, et al. Rehabilitation in Patients With Coronary Heart Disease—participation and its effect on prognosis. Dtsch Arztebl Int. 2015; 112:527-534.