{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T04:08:34Z","timestamp":1792469314378,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,10,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">There is wide variability in cardiac rehabilitation (CR) dose (ie, number of sessions) delivered, and no evidence\u2010based recommendations regarding what dose to prescribe. We aimed to test what CR dose impacts major adverse cardiovascular events (MACEs).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This is an historical cohort study of all patients who had coronary artery disease and who initiated supervised CR between 2002 and 2012 from a single major CR center. CR dose was defined as number of visits including exercise and patient education. Follow\u2010up was performed using record linkage from the Rochester Epidemiology Project. MACEs included acute myocardial infarction, unstable angina, ventricular arrhythmias, stroke, revascularization, or all\u2010cause mortality. Dose was analyzed in several ways, including tertiles, categories, and as a continuous variable. Cox models were adjusted for factors associated with dose and MACE. The cohort consisted of 2345 patients, who attended a mean of 12.5\u00b111.1 of 36 prescribed sessions. After a mean follow\u2010up of 6\u00a0years, 695 (29.65%) patients had a MACE, including 231 who died. CR dose was inversely associated with MACE (hazard ratio, 0.66 [95% CI]; 0.55\u20130.91) in those completing \u226520 sessions, when compared with those not exposed to formal exercise sessions (\u22641 session; log\u2010rank\n              <jats:italic>P<\/jats:italic>\n              =0.007). We did not find evidence of nonlinearity (\n              <jats:italic>P<\/jats:italic>\n              \u22650.050), suggesting no minimal threshold nor ceiling. Each additional session was associated with a lower rate of MACE (fully adjusted hazard ratio, 0.98 [95% CI, 0.97\u20130.99]). Greater session frequency was also associated with lower MACE risk (fully adjusted hazard ratio, 0.74 [95% CI, 0.58\u20130.94]).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">CR reduces MACEs, but the benefit appears to be linear, with greater risk reduction with higher doses, and no upper threshold.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.021356","type":"journal-article","created":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T14:06:44Z","timestamp":1633529204000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":66,"title":["Dose of Cardiac Rehabilitation to Reduce Mortality and Morbidity: A Population\u2010Based Study"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8705-0462","authenticated-orcid":false,"given":"Jose R.","family":"Medina\u2010Inojosa","sequence":"first","affiliation":[{"name":"Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN"},{"name":"Division of Epidemiology Department of Quantitative Health SciencesMayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7063-3610","authenticated-orcid":false,"given":"Sherry L.","family":"Grace","sequence":"additional","affiliation":[{"name":"KITE &amp; Peter Menk Cardiac Centre University Health NetworkUniversity of Toronto Toronto Ontario Canada"},{"name":"Faculty of Health York University Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5178-8315","authenticated-orcid":false,"given":"Marta","family":"Supervia","sequence":"additional","affiliation":[{"name":"Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN"},{"name":"Gregorio Mara\u00f1\u00f3n Health Research InstituteGregorio Mara\u00f1\u00f3n General University Hospital Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8430-8755","authenticated-orcid":false,"given":"Gorazd","family":"Stokin","sequence":"additional","affiliation":[{"name":"International Clinical Research Center St. Anne University Hospital Brno Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9317-4330","authenticated-orcid":false,"given":"Amanda R.","family":"Bonikowske","sequence":"additional","affiliation":[{"name":"Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1448-7182","authenticated-orcid":false,"given":"Randal","family":"Thomas","sequence":"additional","affiliation":[{"name":"Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5788-9734","authenticated-orcid":false,"given":"Francisco","family":"Lopez\u2010Jimenez","sequence":"additional","affiliation":[{"name":"Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.009522"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312809"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.044"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.005453"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487316657669"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2017.07.019"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487317724574"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2001.115785"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.01.078"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.876383"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-303022"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.08.001"},{"key":"e_1_3_1_14_2","first-page":"1","article-title":"Effect of cardiac rehabilitation on cardiovascular events after coronary artery bypass grafting in a 6\u2010year follow\u2010up study study population","volume":"10","author":"Kuo LY","year":"2016","unstructured":"Kuo LY, Shen SL, Hsu CL, Chen BY, Lin YS, Tsai HY, Cheng FH, Lai YL, Lin WH, Huang HY. Effect of cardiac rehabilitation on cardiovascular events after coronary artery bypass grafting in a 6\u2010year follow\u2010up study study population. Health Sci J. 2016;10:1\u20137.","journal-title":"Health Sci J"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2016.01.036"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq482"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.4065\/71.3.266"},{"key":"e_1_3_1_18_2","volume-title":"Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs","author":"American Association of Cardiovascular and Pulmonary Rehabilitation","year":"2013","unstructured":"American Association of Cardiovascular and Pulmonary Rehabilitation . Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs, 5th ed. Human Kinetics; 2013.","edition":"5"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_3_1_20_2","unstructured":"National Center for Health Statistics Council on Clinical Classifications Commission on Professional and Hospital Activities & WHO . The International Classification of Diseases. 9th ed. (Commission on Professional and Hospital Activities editor.). 1978. Available at: https:\/\/www.cdc.gov\/nchs\/icd\/icd9cm.htm. Accessed August 31 2021."},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dys195"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/00008483-200411000-00002"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.20.2194"},{"key":"e_1_3_1_24_2","first-page":"CD007131","article-title":"Interventions to promote patient utilisation of cardiac rehabilitation","volume":"2","author":"de Ara\u00fajo S","year":"2019","unstructured":"de Ara\u00fajo S, Pio C, Chaves GS, Davies P, Taylor RS, Grace SL. Interventions to promote patient utilisation of cardiac rehabilitation. Cochrane Database Syst Rev. 2019;2:CD007131. doi: 10.1002\/14651858.CD007131.pub4","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"e_1_3_1_25_2","first-page":"S206","article-title":"Promoting patient utilization of outpatient cardiac rehabilitation: a joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement","volume":"35","author":"de Ara\u00fajo S","year":"2019","unstructured":"de Ara\u00fajo S, Pio C, Beckie TM, Varnfield M, Sarrafzadegan N, Babu AS, Baidya S, Buckley J, Chen SY, Gagliardi A, et al. Promoting patient utilization of outpatient cardiac rehabilitation: a joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement. Int J Cardiol. 2019;35(10):S206\u2013S207. doi: 10.1016\/j.cjca.2019.07.390","journal-title":"Int J Cardiol"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2011.07.017"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2017-000623"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0b013e3182049f00"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314544084"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2011.11.009"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.983536"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm7120514"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.120.021356","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:58:13Z","timestamp":1715597893000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.021356"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,19]]},"references-count":31,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2021,10,19]]}},"alternative-id":["10.1161\/JAHA.120.021356"],"URL":"https:\/\/doi.org\/10.1161\/jaha.120.021356","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,19]]},"assertion":[{"value":"2021-03-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e021356"}}