Impact of a Medical Fitness Model on Incident Major Adverse Cardiovascular Events: A Prospective Cohort Study of 11 000 Members

Abstract

Background Cardiovascular disease remains the leading cause of disease burden and death in the world. The medical fitness model may be an alternative public health strategy to address cardiovascular risk factors with medical integrated programming. Methods and Results We performed a retrospective cohort study between January 1, 2005, and December 31, 2015. Adults (aged ≥18 years) who did not have a prior major adverse cardiovascular event were included. Controls were assigned a pseudo‐index date at random on the basis of the frequency distribution of start dates in the medical fitness facility group. Multivariate Cox proportional hazards regression models were adjusted for age, sex, socioeconomic status, comorbidities, and year of index date. We stratified the medical fitness facility group into low‐frequency attenders (≤1 weekly visit) and regular‐frequency attenders (>1 weekly visit). Our primary outcome was a hospitalization for nonfatal myocardial infarction and stroke, heart failure, or cardiovascular death. We included 11 319 medical fitness facility members and 507 400 controls in our study. Compared with controls, members had a lower hazard risk of a major adverse cardiovascular event‐plus (hazard ratio [HR], 0.88 [95% CI, 0.81–0.96]). Higher weekly attendance was associated with a lower hazard risk of a major adverse cardiovascular event‐plus compared with controls, but the effect was not significant for lower weekly attendance (low‐frequency attenders: HR, 0.94 [95% CI, 0.85–1.04]; regular‐frequency attenders: HR, 0.77 [95% CI, 0.67–0.89]). Conclusions Medical fitness facility membership and attendance at least once per week may lower the risk of a major adverse cardiovascular event‐plus. The medical fitness model should be considered as a public health intervention, especially for individuals at risk for cardiovascular disease.