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 CR completion 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
CR completion alone was not associated with a lower risk of incident AF. However,
higher baseline CRF and greater CRF improvement had dose-dependent protective effects.
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Article Info
Publication History
Accepted:
June 3,
2022
Received in revised form:
May 30,
2022
Received:
January 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
