Attending Heart School and long-term outcome after myocardial infarction: A decennial SWEDEHEART registry study.
BACKGROUND
The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking.


AIMS
Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction.


METHODS
Patients with first-time myocardial infarction (<75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006-2015), with >99% complete follow-up in the Causes of Death registry for outcome events. Of 192,059 myocardial infarction admissions, 47,907 unique patients with first-time myocardial infarction surviving to the first cardiac rehabilitation visit constituted the study population. The exposure was attending Heart School at the first cardiac rehabilitation visit 6-10 weeks post-myocardial infarction. Data on socioeconomic status was acquired from Statistics Sweden. After multiple imputation, propensity score matching was performed. The association of exposure with mortality was estimated with Cox regression and survival curves.


RESULTS
After matching, attending Heart School was associated (hazard ratio (95% confidence interval)) with a markedly lower risk of both all-cause (two-year hazard ratio = 0.53 (0.44-0.64); five-year hazard ratio = 0.62 (0.55-0.69)) and cardiovascular (0.50 (0.38-0.65); 0.57 (0.47-0.69)) mortality. The results were robust in several sensitivity analyses.


CONCLUSIONS
Attending Heart School during cardiac rehabilitation is associated with almost halved all-cause and cardiovascular mortality after first-time myocardial infarction. The result warrants further investigation through adequately powered randomised trials.
['Wallert|John|J|', 'Olsson|Erik Mg|EM|', 'Pingel|Ronnie|R|', 'Norlund|Fredrika|F|', 'Leosdottir|Margret|M|', 'Burell|Gunilla|G|', 'Held|Claes|C|']
D000368:Aged D000072038:Cardiac Rehabilitation D005260:Female D006126:Group Processes D007722:Health Knowledge, Attitudes, Practice D000082742:Heart Disease Risk Factors D006801:Humans D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D010353:Patient Education as Topic D065840:Protective Factors D012042:Registries D018570:Risk Assessment D055502:Secondary Prevention D013548:Sweden D013997:Time Factors D016896:Treatment Outcome
cardiac rehabilitation Patient education cardiovascular disease prognosis secondary prevention