Cardiac rehabilitation and all-cause mortality in patients with heart failure: A retrospective cohort study

Benjamin J.R. Buckley, Stephanie L. Harrison, Elnara Fazio-Eynullayeva, Paula Underhill, Rajiv Sankaranarayanan, David J. Wright, Dick H.J. Thijssen, Gregory Y.H. Lip

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Aims : Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF). The aim of this study was therefore to investigate the association of exercise-based CR with all-cause mortality, hospitalisation, stroke, and atrial fibrillation in patients with heart failure. Methods and results: A retrospective cohort study was conducted which utilized a global federated health research network, primarily in the USA. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of CR and/or exercise programmes within 6 months of an HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, comorbidities, medications, and procedures (controls). We ascertained 2-year incidence of all-cause mortality, hospitalization, stroke, and atrial fibrillation. Following propensity score matching, a total of 40 364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality [odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62], 26% lower odds of hospitalization (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to controls, after propensity score matching. The beneficial association of CR and exercise on all-cause mortality was consistent across all subgroups, including patients with HFrEF (0.52, 95% CI 0.48-0.56) and HFpEF (0.65, 95% CI 0.60-0.71). Conclusion : Exercise-based CR was associated with lower odds of all-cause mortality, hospitalizations, incident stroke, and incident atrial fibrillation at 2-year follow-up for patients with HF (including patients with HFrEF and HFpEF).

Original languageEnglish
Pages (from-to)1704-1710
Number of pages7
JournalEuropean Journal of Preventive Cardiology
Issue number15
Publication statusPublished or Issued - 1 Dec 2021
Externally publishedYes


  • Cardiac rehabilitation
  • Exercise
  • Heart failure
  • Retrospective cohort
  • Secondary prevention

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

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