Cardiac rehabilitation: a key determinant of post-myocardial infarction outcomes

Background

Myocardial infarction (MI) continues to be highly prevalent in contemporary cardiology practice. Cardiac rehabilitation (CR) is a key component of post-MI care with growing evidence supporting its broad clinical benefits.

Purpose

To assess the medium-term effect of cardiac rehabilitation following MI in terms of symptom burden, cardiovascular hospital admissions and mortality.

Methods

We conducted a retrospective cohort study including consecutive patients admitted with MI between 2021 and 2022 in cardiology department. Demographics, clinical characteristics and MI related data were collected. Three outcomes were assessed in 2025: presence of heart failure symptoms (defined as NYHA class ≥ II), cardiovascular-related hospital admissions and all-cause mortality. Patients were compared according to CR participation (CR vs no CR) using Chi-square or Fisher’s exact tests. A secondary analysis adjusted for age was performed using logistic regression.

Results

A total of 337 patients were initially identified. Twenty-seven patients (8%) were excluded due to severe physical limitations that prevented CR referral. Of the remaining 310 patients referred to CR, 77% (n=237) were male with a mean age of 67 ± 13 years. Forty patients (11%) failed to attend the first CR appointment. Among those who initiated CR, 123 patients (37%) completed the full program. Completion of CR was associated with a significantly lower symptom burden (16% vs 33%, p=0.001). Cardiovascular hospital admissions were infrequent overall (8%), but occurred less often among CR participants (3% vs 12%, p=0.008). Mortality occurred in 26 patients and was also lower in those who attended CR (3% vs 10%, p=0.020).

After age adjustment, CR participation remained independently associated with reduced symptoms (OR 0.44; 95% CI 0.24–0.81; p=0.008) and fewer cardiovascular admissions (OR 0.31; 95% CI 0.10–0.95; p=0.040). Although mortality remained numerically lower among CR participants, the association was no longer statistically significant after adjustment for age (p=0.163).

Conclusion

Cardiac rehabilitation after MI was associated with sustained clinical benefit, including lower symptom burden and reduced cardiovascular hospital admissions. Although mortality reduction did not remain independent of age, the overall findings show support for systematic referral to CR to improve medium-term cardiovascular outcomes.