1240 - Examining the Long-Term Impact of Cardiac Rehabilitation in Patients with Chronic Total Occlusions

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CS

Chirayu Shukla, BS

Medical Student
Carver College of Medicine
Johnston, Iowa, United States

Co-Author(s)

CM

Charles Miks, MD

Resident Physician
University of Iowa Health Care
Iowa City, Iowa, United States
VS

Vikram Sharma, MBBS

Clinical Assistant Professor of Cardiology
University of Iowa Health Care
Coralville, Iowa, United States

Submitter(s)

CS

Chirayu Shukla, BS

Carver College of Medicine
Johnston, Iowa, United States

Objectives: Chronic total occlusions (CTOs) are a common manifestation of coronary artery disease (CAD) that are associated with higher long-term mortality. While successful CTO revascularization improves symptoms and quality of life, a consistent mortality benefit has not been demonstrated among randomized trials. Outpatient cardiac rehabilitation (CR) has proven benefits in improving functional status, exercise capacity, and quality of life in patients with CAD, yet its impact in CTO patients has not been well studied. This study aims to evaluate the association between CR and long-term outcomes in patients with CTOs, highlighting its relevance as a rehabilitation medicine model.

Design: Using the TriNetX Research Network, we analyzed de-identified patient data from 75 healthcare organizations using International Classification of Diseases, Tenth Revision codes. Long-term outcomes for patients with CTO who started CR within 3 months of their initial diagnosis were compared to those who did not. A secondary analysis was performed and p</span>atients with other indications for CR, including coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI), were excluded.

Results: Of 157,968 CTO patients, 10,020 enrolled in CR, including 1,471 without another CR indication. Patients were propensity-matched for independent risk factors for mortality. After 5 years, CR participation was associated with a significant mortality reduction, (HR 0.68; 95% CI, 0.61–0.75; p < 0.0001), even after excluding prior revascularization (HR 0.81; 95% CI, 0.66–0.99; p < 0.045).

Conclusions: This study demonstrates that cardiac rehabilitation is associated with improved long-term survival in patients with CTOs, including for those managed medically or those unable to undergo revascularization. This highlights the potential impact physiatrists can have on chronic diseases by leading exercise-based, functional, and multidisciplinary rehabilitation programs, which can be expanded to high-risk populations beyond traditional cardiovascular care