Multifactorial effects of outpatient cardiac rehabilitation in patients with heart failure: a nationwide retrospective cohort study

Abstract Aims Although cardiac rehabilitation (CR) is a strongly recommended therapy, no large study has assessed the effects of outpatient CR in patients with heart failure (HF) in real-world settings. Therefore, this study aimed to investigate the multifactorial effects of outpatient CR in patients with HF using a nationwide database. Methods and results This nationwide retrospective cohort study was performed using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with acute HF who underwent inpatient CR between April 2014 and March 2020 were included. The association between outpatient CR participation and all-cause mortality, rehospitalization for HF, use of medical resources, and medical costs was analysed using propensity score matching analysis. Of 250 528 patients, 17 884 (7.1%) underwent outpatient CR. After propensity score matching, the CR (+) group was associated with a reduction in the risk of all-cause mortality [hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.60–0.68, P < 0.001] and rehospitalization for HF compared with the CR (−) group (HR: 0.87, 95% CI: 0.82–0.92, P < 0.001). The proportion of guideline-based medication use for HF at 1 year was higher in the CR (+) group than in the CR (−) group. The total medical costs from the index hospitalization to 1.5 years after admission were similar between the groups. Conclusion Outpatient CR participation after discharge from HF was associated with reduced mortality and rehospitalization for HF without increasing medical costs.