Physicians' Academy for Cardiovascular Education

Exercise-based cardiac rehabilitation after MI reduces total mortality in men and women

Participation in exercise-based cardiac rehabilitation is related to reduced total mortality in both men and women: results from the SWEDEHEART registry

Literature - Ekblom Ö, Cider A, Hambraeus K et al. - Eur J Prev Cardiol. 2021 Jun 7;zwab083. doi: 10.1093/eurjpc/zwab083.

Introduction and methods

Previous studies have shown that participation in exercise-based cardiac rehabilitation (exCR) after MI reduces the risk on CVD mortality [1-3]. Moreover, the ESC has given participation in exCR a class 1A recommendation post-MI [4,5]. However, whether exCR post-MI has beneficial effects on total mortality has remained unclear and gender-specific analyses have not been performed in previous studies investigating effects of exCR. This study assessed the association between participation in exCR and total mortality in men and women in the SWEDEHEART registry.

The SWEDEHEART registry is a large, unselected nationwide cohort of patients, which contains continuous information on acute care and secondary prevention for patients with MI in Sweden [6]. The present analysis included a total of 20 895 patients (74% men) aged between 18 and 75 years who were diagnosed with a first MI and with complete data on covariates, explanatory and outcome variables. Of these 20 895 patients, 9647 (46%) participated in exCR, defines as center-based supervised exercise sessions, at least two times per week. The primary outcome was total mortality. Mean follow-up (time between index MI and date of death or end of study) was 4.55 (SD 2.33) years. A total of 1000 deaths occurred during this follow-up time.

Main results


This study in an unselected nationwide cohort of patients with MI showed that participation in exCR after MI significantly reduced total mortality. The association between participation in exCR and lower total mortality was more pronounced in women than in men and in patients with low HRQoL compared to those with high HRQoL.

The authors state that: ‘Our results further support the recommendations to participate in exCR, and hence we argue that exCR should be a mandatory part of comprehensive CR programmes, offered to all patients post-MI.’


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Find this article online at Eur J Prev Cardiol.

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