Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study.

Eser, Prisca; Marcin, Thimo; Prescott, Eva; Prins, Leonie F; Kolkman, Evelien; Bruins, Wendy; van der Velde, Astrid E; Peña-Gil, Carlos; Iliou, Marie-Christine; Ardissino, Diego; Zeymer, Uwe; Meindersma, Esther P; Van'tHof, Arnoud W J; de Kluiver, Ed P; Laimer, Markus; Wilhelm, Matthias (2020). Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study. Cardiovascular diabetology, 19(1), p. 37. BioMed Central 10.1186/s12933-020-01013-8

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BACKGROUND The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. We aimed to compare the effectiveness of current cardiac rehabilitation (CR) programs across seven European countries between elderly cardiac patients with and without DM. METHODS 1633 acute and chronic coronary artery disease (CAD) patients and patients after valve intervention with an age 65 or above who participated in comprehensive CR (3 weeks to 3 months, depending on centre) were included. Peak oxygen uptake (VO2 peak), body mass index, resting systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C), and glycated haemoglobin (HbA1c) were assessed before start of CR, at termination of CR (variable time point), and 12 months after start of CR, with no intervention after CR. Baseline values and changes from baseline to 12-month follow-up were compared between patients with and without DM using mixed models, and mortality and hospitalisation rates using logistic regression. RESULTS 430 (26.3%) patients had DM. Patients with DM had more body fat, lower educational level, more comorbidities, cardiovascular risk factors, and more advanced CAD. Both groups increased their VO2 peak over the study period but with a significantly lower improvement from baseline to follow-up in patients with DM. In the DM group, change in HbA1c was associated with weight change but not with change in absolute VO2 peak. 12-month cardiac mortality was higher in patients with DM. CONCLUSIONS While immediate improvements in VO2 peak after CR in elderly patients with and without DM were similar, 12-month maintenance of this improvement was inferior in patients with DM, possibly related to disease progression. Glycemic control was less favourable in diabetic patients needing insulin in the short- and long-term. Since glycemic control was only related to weight loss but not to increase in exercise capacity, this highlights the importance of weight loss in obese DM patients during CR. Trial registration NTR5306 at trialregister.nl; trial registered 07/16/2015; https://www.trialregister.nl/trial/5166.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Eser, Prisca; Marcin, Thimo; Laimer, Markus and Wilhelm, Matthias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1475-2840

Publisher:

BioMed Central

Language:

English

Submitter:

Thimo Marcin

Date Deposited:

22 Apr 2020 09:15

Last Modified:

26 Apr 2020 02:47

Publisher DOI:

10.1186/s12933-020-01013-8

PubMed ID:

32192524

Uncontrolled Keywords:

BMI Cardiac rehabilitation Cardiovascular risk factors Exercise capacity HbA1c LDL-C Peak VO2 Systolic blood pressure

BORIS DOI:

10.7892/boris.142723

URI:

https://boris.unibe.ch/id/eprint/142723

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