Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation
Abstract
Background — Predicting the risk of cardiac and all-cause death in patients with established coronary heart disease is important in counseling the individual and designing risk-stratified rehabilitation and secondary prevention programs. Cox proportional hazards and Kaplan-Meier survival curves were thus completed on initial assessment data obtained from patients referred to an outpatient cardiac rehabilitation center. Methods and Results — A single-center prospective observational design took peak cardiorespiratory exercise test data for 12 169 male rehabilitation candidates aged 55.0±9.6 years (7096 myocardial infarctions [MIs], 3077 coronary artery bypass grafts [CABGs], and 1996 documented cases of ischemic heart disease [IHD]). A follow-up of 4 to 29 years (median, 7.9) yielded 107 698 man-years of experience. Entry data were tested for associations with time to cardiac and all-cause death. We recorded 1336 cardiac deaths (953 MI, 225 CABG, and 158 IHD) and 2352 all-cause deaths. A powerful predictor of cardiac and all-cause mortality was measured peak oxygen intake (V̇ o 2peak ). For the overall sample, values of <15, 15 to 22, and >22 mL/kg per minute yielded respective multivariate adjusted hazard ratios of 1.00, 0.62, and 0.39 for cardiac and 1.00, 0.66, and 0.45 for all-cause deaths. For the separate diagnostic categories, apart from V̇ o 2peak , the only other significant predictors of cardiac death common to all 3 were smoking and digoxin, and for all-cause death, age, smoking, digoxin, and diabetes. Conclusions — Exercise capacity, as determined by direct measurement of V̇ o 2peak , exerts a major long-term influence on prognosis in men after MI, CABG, or IHD and can play a valuable role in risk stratification and counseling.
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Cardiorespiratory fitness is one of the strongest prognostic markers in persons with and without chronic disease, including cardiovascular disease.
“Numerous studies now suggest that CRF is one of the strongest prognostic markers in persons with and without chronic disease, including CVD [13] , [14] , [15] , [16] .”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [14]
Observational studies have shown that even a 1 mL/kg/min increase in peak oxygen uptake has been associated with a substantial impact on survival and incidence of fatal and non-fatal coronary heart disease.
“Observational studies have shown that even a 1 mL/kg/min increase in peak oxygen uptake has been associated with a substantial impact on survival23 38 39 40 and incidence of fatal and non-fatal coronary heart disease.41”
From Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial (2020) · cites this paper as [39]
In large populations of male and female cardiovascular patients, cardiovascular fitness (METs) has an inverse dose-response relationship with all-cause mortality, irrespective of beta-blocker use.
“recent data confirm the existence of an inverse dose-response relationship between cardiovascular fitness (evaluated by treadmill stress testing and expressed in METs) and all-cause mortality in large populations of both male and female cardiovascular patients”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [334]
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- Authors
- Kavanagh, T., Mertens, D. J., Hamm, L. F., Beyene, J., Kennedy, J., Corey, P., & Shephard, R. J.
- Affiliations
- University of Toronto (CA)
- Venue
- Circulation
- Published
- 2002-08-06
- Volume
- 106
- Issue
- 6
- Pages
- 666-671
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2171806229
- Cited by
- 648
- References
- 30
- Citations by year
- 2026: 15 · 2025: 18 · 2024: 31 · 2023: 28 · 2022: 30 · 2021: 26 · 2020: 27 · 2019: 24 · 2018: 22 · 2017: 46 · 2016: 39 · 2015: 32 · 2014: 25 · 2013: 39 · 2012: 45
- FWCI
- 9.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- cardiac rehabilitation, long-term prognosis, mortality prediction, exercise capacity, coronary artery disease, myocardial infarction, coronary artery bypass grafting, ischemic heart disease, risk stratification, smoking, digoxin, diabetes mellitus, men
- MeSH terms
- Coronary Artery Bypass, Coronary Disease, Exercise Test, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Prognosis, Prospective Studies, Survival Rate, Proportional Hazards Models, Myocardial Ischemia
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