LAUSR

BACKGROUND The risk of major adverse cardiovascular events is substantially increased following a stroke. Although exercise-based cardiac rehabilitation has been shown to improve prognosis following cardiac events, it is not part of routine care for people following a stroke. We therefore investigated the association between cardiac rehabilitation and major adverse cardiovascular events for people with stroke. METHODS This retrospective analysis was conducted on June 20, 2021, using anonymized data within TriNetX, a global federated health research network with access to electronic medical records from participating healthcare organizations, predominantly in the USA. All participants were aged ≥18 years with cerebrovascular disease and at least 2 years of follow-up. People with stroke and an electronic medical record of exercise-based cardiac rehabilitation were 1:1 propensity score matched to people with stroke but without cardiac rehabilitation using participant characteristics, comorbidities, cardiovascular procedures, and cardiovascular medications. RESULTS Of 836,923 people with stroke and 2-year follow-up, 2,909 met the inclusion for the exercise-based cardiac rehabilitation cohort. Following propensity score matching (n = 5,818), exercise-based cardiac rehabilitation associated with 53% lower odds of all-cause mortality (odds ratio 0.47, 95% confidence interval: 0.40-0.56), 12% lower odds of recurrent stroke (0.88, 0.79-0.98), and 36% lower odds of rehospitalization (0.64, 0.58-0.71), compared to controls. No significant association between cardiac rehabilitation and incident atrial fibrillation was observed. CONCLUSION Exercise-based cardiac rehabilitation prescribed for people following a stroke associated with significantly lower odds of major adverse cardiovascular events at 2 years, compared to usual care.