Cardiac rehabilitation reduces hospital admissions and improves quality of life Exercise as medicine benefits all patient groups

Cardiac rehabilitation following a myocardial infarction or angina pectoris leads to fewer hospital admissions and improves the quality of life for heart patients, according to a large meta-analysis led by Radboud university medical center, in collaboration with researchers from Liverpool and Glasgow. The study shows that these benefits apply to all patient groups, and that improvements in quality of life are even greater among individuals with practical educational levels. As such, cardiac rehabilitation contributes to reducing health disparities.

In the Netherlands, approximately 66,000 people experienced a myocardial infarction in 2023, and around 27,000 new patients presented with angina pectoris. International guidelines have long recommended cardiac rehabilitation for individuals with coronary artery disease.

This program typically includes supervised physical activity, such as walking or cycling, often combined with education and social support. Cardiac rehabilitation serves multiple purposes. A key goal is to prevent recurrence of cardiovascular disease. This form of secondary prevention promotes better overall health. In addition, the program helps people feel better and experience fewer symptoms.

Exercise as medicine

For this large meta-analysis, researchers led by Radboudumc combined data from nearly 5,000 individuals with coronary artery disease across eight recent international studies. Half of the participants took part in a cardiac rehabilitation program, while the other half did not. The researchers aimed to assess how effective these programs are in current medical practice, and whether they work better for certain groups.

The results show that heart patients who participated in cardiac rehabilitation were less likely to be hospitalized in the three years following the program—both due to new cardiac events (38%) and other causes (32%). They also reported a better quality of life up to one year after completing the program. No difference in life expectancy was found between the two groups.

Additional benefits for vulnerable groups

The researchers also found that some individuals benefited more from exercise-based cardiac rehabilitation. This was especially true for those with physical limitations, such as reduced fitness, a history of heart disease, or impaired heart function. Moreover, quality of life improved more significantly among individuals with lower educational levels compared to those with higher education. Yet, in practice, patients with more severe heart conditions and practical education levels are referred less often, which may contribute to growing health disparities.

Niels Stens, first author of the article, explains: ‘These results show that everyone with specific heart conditions can benefit from cardiac rehabilitation. It offers health gains for a broad group of people with heart problems, regardless of age, gender, or baseline health. This demonstrates that this form of prevention is valuable for all.’

Improving access and prevention

Despite strong recommendations in international guidelines, participation in cardiac rehabilitation remains relatively low. ‘Previous research from Radboudumc shows that only about one-third of people with cardiovascular disease receive cardiac rehabilitation. There is still significant room for improvement,’ says lead researcher Dick Thijssen. He advocates for better access and referral systems, such as automated referrals, home-based programs, and digital support. Cardiac rehabilitation not only prevents complications but can also help reduce health disparities. It therefore deserves a place in both healthcare and prevention policy.

About the publication

This research was published in the European Journal of Preventive Cardiology: Exercise-based Cardiac Rehabilitation for Coronary Heart Disease – the CaReMATCH individual participant data meta-analysis. Authors: Niels A. Stens, Benjamin JR Buckley, Grace O. Dibben, Laurien M. Buffart, Geert Kleinnibbelink, Dorairaj Prabhakaran, Ambalam M. Chandrasekaran, Sanjay Kinra, Ambuj Roy, Gianluca Campo, Arto J. Hautala, Johan A. Snoek, Ralph Maddison, Núria Santaularia, Scott A. Lear, Julie Houle, Gregory Y.H. Lip, Niels van Royen, Rod S. Taylor, Dick H.J. Thijssen, CaReMATCH collaborators. DOI: 10.1093/eurjpc/zwaf629

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