Exercise rehabilitation associates with lower mortality and hospitalisation in cardiovascular disease patients with COVID-19

Abstract: RESEARCH LETTER European Journal of Preventive Cardiology doi:10.1093/eurjpc/zwaa135 Exercise rehabilitation associates with lower mortality and hospitalisation in cardiovascular disease patients with COVID-19 Benjamin J.R. Buckley 1*, Stephanie L. Harrison1, Elnara Fazio-Eynullayeva2, Paula Underhill3, Ian D. Jones4, Nefyn Williams5, and Gregory Y.H. Lip1,4,6 1 Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK; 2TriNetX Inc, Cambridge, MA, USA; 3TriNetX Inc, London, UK; 4Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK; 5Department of Primary Care and Mental Health, University of Liverpool, UK; and 6Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Received 21 October 2020; revised 9 November 2020; editorial decision 10 November 2020 The COVID-19 pandemic has caused global health, social, and economic system challenges. In an effort to try and reduce transmission rates, most countries have varying levels of societal ‘lockdowns’ and social restrictions in place. This creates a unique challenge for the promotion of physical activity and exercise, which we know has profound physical and mental health benefits. Although there was initial promise of increased population interest in physical activity and exercise at the beginning of the COVID-19 pandemic,1 recent large-scale data from over 455 000 people has demonstrated a 27% decrease in average daily steps within 30 days of the pandemic declaration.2 It may therefore be more important now than ever to facilitate physical activity and exercise promotion during and post-COVID19. Despite, recent collaborative efforts developing post-COVID-19 guidelines for athletes returning to exercise,3 limited evidence is available for the impact of exercise and cardiac rehabilitation (CR) on clinical outcomes following-COVID-19. Secondary prevention through comprehensive CR has been recognized as the most costeffective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular diseases.4 Given there is a high prevalence of cardiovascular disease among patients with COVID-19, and >7% experience COVID-19 induced myocardial injury,5 CR following COVID-19 infection warrants investigation. The objective of this study was therefore to compare mortality, hospitalization, and cardiovascular comorbidity between patients with cardiovascular disease and COVID-19 with and without an electronic medical record (EMR) of CR or exercise programmes. This retrospective observational study was conducted in October 2020 with anonymized data provided by TriNetX, a global federated health research network with access to EMRs from participating academic medical centres, specialty physician practices, and community hospitals, predominantly in the USA. Patients with COVID-19 were identified via Centers for Disease Control and Prevention (CDC) coding using ICD-10-CM codes, or specific laboratory Logical .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Observation Identifiers Names and Codes.6 All patients were aged >_18 years with COVID-19 recorded in EMRs between 20 January 2020 (date COVID-19 first confirmed in the USA)7 and 26 May 2020 (to allow 4-month follow-up). Cardiac rehabilitation was..