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Canadian Journal of Cardiology

Cardiac Rehabilitation and Risk of Incident Atrial Fibrillation in Patients With Coronary Artery Disease

  • Hongwei Liu
    Affiliations
    Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Danielle A. Southern
    Affiliations
    Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Ross Arena
    Affiliations
    TotalCardiology Research Network, Calgary, Alberta, Canada

    Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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  • Tolulope Sajobi
    Affiliations
    Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Sandeep Aggarwal
    Affiliations
    Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    TotalCardiology Research Network, Calgary, Alberta, Canada

    TotalCardiology Rehabilitation, Calgary, Alberta, Canada
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  • Matthew T. James
    Affiliations
    Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Stephen B. Wilton
    Correspondence
    Corresponding author: Dr Stephen B. Wilton, GE64 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada. Tel.: +1-403-210-7102; fax: +1-403-210-9180.
    Affiliations
    Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    TotalCardiology Research Network, Calgary, Alberta, Canada
    Search for articles by this author

      Abstract

      Background

      Patients with coronary artery disease (CAD) are at risk for developing atrial fibrillation (AF). Whether attending a cardiac rehabilitation (CR) program can attenuate this risk is unclear.

      Methods

      This retrospective cohort study included patients who were free of pre-existing AF and referred to CR after coronary revascularization between April 2004 and March 2015 in Calgary, Canada. Patients with incident AF were identified using administrative data and the local electrocardiogram repository. Exposure variables and covariates were extracted from electronic medical records of a CR program and a clinical registry.

      Results

      The study included 11,662 patients (mean age [standard deviation], 60.9 [10.9] years; male, 80.6%). In a median follow-up of 4.8 years, the cumulative incidence rate of AF was 1.04 per 100 person-years. There was no association between completion of CR and the risk of incident AF after adjusting for baseline characteristics (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.83-1.15). However, each higher metabolic equivalent (MET) of baseline cardiorespiratory fitness (CRF) and each MET gain in CRF following CR were independently associated with a 12% (95% CI, 6%-18%) and 18% (95% CI, 6%-28%) lower relative risk of incident AF, respectively. The risk of incident AF declined progressively, with the baseline CRF increasing up to 9.0 peak METs and with the 12-week CRF increasing up to 10.3 peak METs; beyond these peak MET levels, benefits plateaued.

      Conclusions

      Completion of CR alone was not associated with a lower risk of incident AF. However, higher baseline CRF and greater CRF improvement had dose-dependent protective effects.

      Résumé

      Contexte

      Les patients atteints de coronaropathie présentent un risque de fibrillation auriculaire (FA). L’effet de la participation à un programme de réadaptation cardiaque (RC) sur ce risque est encore incertain.

      Méthodologie

      Cette étude de cohorte rétrospective comprenait des patients exempts d’antécédents de FA et orientés en RC après avoir subi une revascularisation coronarienne entre avril 2004 et mars 2015 à Calgary (Canada). Les patients chez qui une FA est apparue ont été recensés à l’aide de données administratives et du répertoire local d’électrocardiogrammes. Les variables d’exposition et les covariables ont été obtenues à partir des dossiers médicaux électroniques d’un programme de RC et d’un registre clinique.

      Résultats

      L’étude comprenait 11 662 patients (âge moyen [écart-type] de 60,9 [10,9] ans; 80,6 % d’hommes). La durée médiane de suivi était de 4,8 ans, et le taux d’incidence cumulative de FA était de 1,04 pour 100 années-personnes. Aucune association n’a été décelée entre la participation à un programme de RC et le risque de FA, après un ajustement pour tenir compte des caractéristiques initiales des patients (rapport des risques instantanés [RRI] de 0,97; intervalle de confiance [IC] à 95 % : de 0,83 à 1,15). Toutefois, les hausses de la valeur de l’équivalent métabolique (MET) de la capacité cardiorespiratoire (CCR) au départ et les gains en MET de la CCR après la RC ont été associés, de manière indépendante, à un risque relatif de survenue d’une FA plus faible de 12 % (IC à 95 % : de 6 % à 18 %) et de 18 % (IC à 95 % : de 6 % à 28 %), respectivement. Le risque de survenue d’une FA diminuait progressivement, la CCR au départ s’élevant jusqu’à 9,0 MET et la CCR à 12 semaines s’élevant jusqu’à 10,3 MET; aucun bénéfice supplémentaire n’a été observé au-delà de ces valeurs.

      Conclusions

      La seule participation à un programme de RC n’était pas associée à un risque plus faible de survenue de FA. Toutefois, des valeurs initiales plus élevées de CCR et une plus grande amélioration des valeurs de la CCR ont exercé un effet protecteur proportionnel aux valeurs.
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