All-cause mortality benefits of attending phase 3 cardiac rehabilitation: A systematic review.

AIM: The primary objective of this study was to assess the impact of attending a phase 3 cardiac rehabilitation (CR) program on all-cause mortality outcomes. METHODS: We conducted a systematic review using database searches (MEDLINE and Cochrane Central Register of Controlled Trials) up to December 2022 to identify studies that compared adult patients undergoing phase 3 of CR with those receiving usual care. RESULTS: Out of a total of 1867 identified articles, eight met the eligibility criteria (two randomized controlled trials (RCT) and six non-RCT) and were included (N= 60,939 patients; 82% male, average age of 62±11 years). Phase 3 of a CR program showed a significant association with reduced mortality rates, displaying a Hazard Ratio (HR) of 0.56 (95% CI 0.49-0.65), with minimal evidence of statistical heterogeneity. The studies presented a range of differently organized CR programs. They varied in duration, training methods, and incorporated components. CONCLUSION: This systematic review demonstrates that attending a phase 3 CR program has the beneficial effect of reducing mortality among patients with cardiovascular disease, in particular those with coronary artery disease. These findings highlight the importance of CR participation on a long-term basis and reinforce the value of globally increasing the number of specialized centers and optimizing patient referrals to participate in a phase 3 CR long-term program.