Diabetic patients could benefit from cardiac rehab—but doctors aren't referring them

Diabetic patients who have undergone percutaneous coronary intervention (PCI) could see a significant reduction in risk of mortality if they participate in cardiac rehabilitation programs, Randal J. Thomas, MD, and colleagues wrote in a study published in the Journal of the American Heart Association.

Cardiac rehab (CR) is known to be an effective risk-reducer in individuals living with coronary artery disease, Thomas and colleagues wrote, but little information exists on its benefits in the high-risk population of diabetics who undergo PCI.

Thomas and his team analyzed all patients with diabetes mellitus (DM) who went through a PCI procedure in Olmsted County, Minnesota, between 1994 and 2010, narrowing the field to around 700 subjects. Their aim, they wrote, was to assess the impact of CR participation on the clinical outcomes of these patients.

The researchers found that, compared with a non-diabetic population, participation by patients with DM in rehabilitation programs was significantly lower—just 38 percent of the total pool went through CR. However, the all-cause mortality rate in diabetic patients was also significantly reduced, implying that cardiac rehab could be beneficial to a population who isn’t receiving enough of it.

“Despite the significant benefits of CR, low rates of referral to CR have been noted after PCI in the United States between 2009 and 2012, with only around 60 percent of patients after PCI being referred to CR at hospital discharge,” Thomas and co-authors wrote in the study. “Results obtained herein also reflect a need for greater CR participation by patients after PCI.”

The authors wrote that factors like hospital size, procedure volume, geographic location and presence of systematic CR programs could be more important barriers to patients referred for CR than patient-level factors like age and comorbidities.

In the study, patients with DM also saw lower rates of myocardial infarctions and revascularizations if they undertook a CR program, Thomas and colleagues reported.

In patients without DM, cardiac rehab was still a largely beneficial in reducing all-cause mortality rates and cardiac mortality.

“These findings are important because they support, with community-based data, the hypothesis that CR participation is associated with lower mortality in patients with DM, and that this benefit is similar to the benefit noted in patients without DM,” Thomas and co-authors wrote. “This study is unique in that it assessed the association between CR participation and cardiovascular outcomes after PCI in people with and without DM, using extensive procedural, hospital and posthospitalization data.”