Effectiveness of the innovative Austrian phase III cardiac rehabilitation model on cardiovascular risk factors: a nationwide registry

INTRODUCTION: The Austrian model of outpatient cardiac rehabilitation (CR) begins right after discharge from the acute care hospital. During phase II (OUT-II), it provides a facility-based, professionally supervised, multidisciplinary programme of 6 weeks. The subsequent, supervised phase III (OUT-III) lasts 6 months. In 2017, a 3-6 months lasting unsupervised home-based training has been added, which is followed by a 4-week facility-based evaluation and training period, called 'refresher'. We aimed to assess the effectiveness of this programme using a nationwide registry.

METHODS: Anthropometric data, resting blood pressure, lipid profile, maximum exercise capacity (Pmax), anxiety (HADS-A) and depression (HADS-D) of all patients (n=1458) who participated in OUT-III between 1 January 2018 and 30 August 2022 were analysed. Data were assessed at the beginning of OUT-III (OUT-IIIstart), end of the supervised period (OUT-IIIend) and during the refresher (OUT-IIIrefresher).

RESULTS: From OUT-IIIstart to OUT-IIIend, Pmax (155±1.4 W to 167±1.6 W; p<0.001) and high-density lipoprotein (HDL) increased (49±0.4 mg/dL to 51±0.4 mg/dL; p<0.001), low-density lipoprotein (LDL) decreased (82±1.0 mg/dL to 79±1.1 mg/dL; p<0.001), while total cholesterol (CHOL) remained statistically unchanged (150±43.3 mg/dL to 149±43 mg/dL; p<0.999). From OUT-IIIend to OUT-IIIrefresher, Pmax slightly decreased (164±1.6 W; p<0.001), HDL further increased (52±0.5 mg/dL; p<0.020), whereas LDL (79±1.3 mg/dL; p<0.999) and CHOL remained unchanged (149±41 mg/dL; p<0.999).Anxiety (4.8±0.1 aU, 4.2±0.1 aU; p<0.001, 4.0±0.1 aU; p<0.001) and depression (3.7±0.1 aU, 34±0.1 aU; p<.001, 3.1±0.1 aU; p<0.001) continuously decreased from OUT-IIIstart to OUT-IIIend and the OUT-IIIrefresher.

CONCLUSION: OUT-III CR resulted in sustained improvement in Pmax, blood lipids, anxiety and depression.