Beneficial effects of cardiac rehabilitation after acute coronary syndrome and coronary artery bypass grafting: Real-world evidence from the Cardiac Rehabilitation Outcome Study update (CROS-III).

@article{salzwedel2026beneficial,
  title = {{Beneficial effects of cardiac rehabilitation after acute coronary syndrome and coronary artery bypass grafting: Real-world evidence from the Cardiac Rehabilitation Outcome Study update (CROS-III).}},
  author = {Annett Salzwedel and Johannes A Vey and Birna Bjarnason-Wehrens and Axel Schlitt and Bernhard Schwaab and Elena Tessitore and Amina Cheikh Rouhou and David Niederseer and Mahdi Sareban and Greta Hametner and Maria-Inti Metzendorf and Gloria Petrasch and Steffen Schneider and Jean-Paul Schmid and Bernhard Rauch and Constantinos H Davos},
  journal = {European heart journal open},
  year = {2026},
  month = sep,
  doi = {10.1093/ehjopen/oeag152},
  url = {https://europepmc.org/article/MED/42953095},
  note = {CC BY-NC},
}

TY  - JOUR
TI  - Beneficial effects of cardiac rehabilitation after acute coronary syndrome and coronary artery bypass grafting: Real-world evidence from the Cardiac Rehabilitation Outcome Study update (CROS-III).
AU  - Annett Salzwedel
AU  - Johannes A Vey
AU  - Birna Bjarnason-Wehrens
AU  - Axel Schlitt
AU  - Bernhard Schwaab
AU  - Elena Tessitore
AU  - Amina Cheikh Rouhou
AU  - David Niederseer
AU  - Mahdi Sareban
AU  - Greta Hametner
AU  - Maria-Inti Metzendorf
AU  - Gloria Petrasch
AU  - Steffen Schneider
AU  - Jean-Paul Schmid
AU  - Bernhard Rauch
AU  - Constantinos H Davos
PY  - 2026
DA  - 2026/09/01
JO  - European heart journal open
DO  - 10.1093/ehjopen/oeag152
UR  - https://europepmc.org/article/MED/42953095
AB  - To review the effects of cardiac rehabilitation (CR) in patients with acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) and in mixed populations treated with contemporary interventional, surgical and pharmacological therapy. A systematic review and meta-analysis (PROSPERO CRD42025630588) including randomized controlled trials (RCT) and prospective/retrospective controlled cohort studies (pCCS/rCCS) was performed with total mortality as main endpoint. Additional endpoints were cardiovascular mortality, non-fatal cardiovascular events, and hospital readmissions. Subgroup analysis was performed for age and sex. From 40 included studies, 29 studies encompassing 308 514 patients were eligible for this meta-analysis, including 5 newly identified (published between 11/2018-09/2025) studies with 92 571 patients. In pCCS and rCCS, CR-participation was associated with significantly reduced total mortality in patients with ACS (n = 41 740; pCCS: HR 0.33, 95% CI 0.15-0.69; rCCS: HR 0.64, 95% CI 0.55-0.75) and with CABG (n = 17 998; rCCS: HR 0.65, 95% CI 0.56-0.76). The effects regarding total mortality were similar in sex and age subgroups. Cardiovascular mortality and non-fatal stroke were decreased in ACS and CABG patients. In mixed populations, CR was associated with reduced hospital readmissions for any reason and for any cardiovascular event. Methodological and structural heterogeneity and low patient numbers prevented robust results. Based on observational data, participation in CR is associated with an improved prognosis in current patients after ACS, CABG and mixed populations, similarly for sex and age subgroups. Hence, CR should be an integral part of secondary prevention in those patients. Nevertheless, high-quality studies are needed to increase the CR evidence base further.
SN  - 2752-4191
ER  -