1. Ozemek, Cemal PhD
  2. Arena, Ross PhD, PT
  3. Rouleau, Codie R. PhD
  4. Campbell, Tavis S. PhD
  5. Hauer, Trina MSc
  6. Wilton, Stephen B. MD, MSc
  7. Stone, James MD, PhD
  8. Laddu, Deepika PhD
  9. Williamson, Tamara M. MSc
  10. Liu, Hongwei MD, MSc
  11. Chirico, Daniele PhD
  12. Austford, Leslie D. MN, MBA, CMPE
  13. Aggarwal, Sandeep MD


Purpose: The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR).


Methods: This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and March 2016, with follow-up through March 2017. Patients were stratified by the presence of multimorbidity, which was defined as having a diagnosis of >=2 noncommunicable diseases (NCDs). Cox regression analyses were used to evaluate the effects of multimorbidity and CRF on mortality in patients completing CR. Symptom-limited exercise tests were completed at baseline, immediately following CR (12 wk), with a subgroup completing another test at 1-yr follow-up. Peak metabolic equivalents (METs) were determined from treadmill speed and grade.


Results: Of the 8320 patients (61 +/- 10 yr, 82% male) included in the analyses, 5713 (69%) patients only had CVD diagnosis, 2232 (27%) had CVD+1 NCD, and 375 (4%) had CVD+>=2 NCDs. Peak METs at baseline (7.8 +/- 2.0, 6.9 +/- 2.0, 6.1 +/- 1.9 METs), change in peak METs immediately following CR (0.98 +/- 0.98, 0.83 +/- 0.95, 0.76 +/- 0.95 METs), and change in peak METs 1 yr after CR (0.98 +/- 1.27, 0.75 +/- 1.17, 0.36 +/- 1.24 METs) were different (P < .001) among the subgroups. Peak METs at 12 wk and the presence of coexisting conditions were each predictors (P < .001) of mortality. Improvements in CRF by >=0.5 METS from baseline to 1-yr follow-up among patients with or without multimorbidity were associated with lower mortality rates.


Conclusion: Increasing CRF by >=0.5 METs improves survival regardless of multimorbidity status.