Author(s): LU, J.W., CHEN, T., LIANG, C., Institution: HUALIEN TZU CHI HOSPITAL, Country: TAIWAN, Abstract-ID: 269

INTRODUCTION:
Coronavirus disease 2019 (COVID-19) is associated with poor cardiac outcomes and increased risks of long-term cardiovascular diseases. Previous small case series have shown that exercise-based rehabilitation could benefit COVID-19 patients by decreasing symptoms such as dyspnea or fatigue. Nevertheless, the long-term cardiovascular outcomes among COVID-19 patients after exercise-based cardiac rehabilitation were largely unknown. Therefore, we aimed to investigate the long-term cardiovascular outcomes among COVID-19 survivors after exercise-based cardiac rehabilitation using real-world data.
METHODS:
In this retrospective nationwide study, we analyzed data from the US Collaborative Network of the TriNetX Research Database. Adults aged ≥ 18 years diagnosed with COVID-19 between 2020 and 2022 were enrolled for inclusion. We excluded patients who died within 30 days after COVID-19 diagnosis to ensure that all enrollees were COVID-19 survivors. The comparison comprised a cohort of patients receiving exercise-based cardiac rehabilitation and a cohort of 1:1 propensity score-matched control patients. Multiple covariates, such as age, sex, race, ethnicity, comorbidities, and baseline medication use, were incorporated to calculate the propensity score. We excluded participants with a history of outcomes of interest. A Cox regression model with considering inverse probability weighting was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes. Stratified analyses according to age, sex, race, and ethnicity were also performed.
RESULTS:
Overall, a total of 17,340 participants were included. During the follow-up, COVID-19 survivors that received exercise-based cardiac rehabilitation had a lower risk of myocardial infarction (HR = 0.75, 95% CI = 0.61-0.89), stroke (HR = 0.81, 95% CI = 0.68-0.94), myocarditis (HR = 0.81, 95% CI = 0.70-0.94), heart failure (HR = 0.73, 95% CI = 0.65-0.83), pulmonary embolism (aHR = 0.78, 95% CI = 0.63-0.92), and mortality (aHR = 0.75, 95% CI = 0.63-0.89) compared to those without rehabilitation. The decreased risks remained significant among men, white people, and those aged more than 65 years.
CONCLUSION:
In conclusion, COVID-19 survivors receiving exercise-based cardiac rehabilitation are associated with decreased risks of incident myocardial infarction, stroke, myocarditis, heart failure, pulmonary embolism, and mortality. Exercise-based rehabilitation may be considered among patients with patients after COVID-19 infection.