Comprehensive cardiac rehabilitation: A cost assessment based on a randomized clinical trial

Kruse, Marie; Hochstrasser, Stefan; Zwisler, Ann-Dorthe O.; Kjellberg, Jakob

doi:10.1017/s0266462306051403

Cited by 8 publications

(5 citation statements)

References 4 publications

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“…Many previously published studies demonstrate an improvement in QOL after CR in patients with cardiovascular diseases, although the results came from different models of CR programs (home-based, hospital-based and ambulatory) and different groups of patients. [12][13][14][15][16][17][18][19][20][21][22][23][39][40][41] An improvement in the exercise capacity of CR patients as a result of physical activity similar to our results was also observed in previous studies. 3,5,44,45 We found no correlation between increasing exercise capacity and the improvement in health-related QOL according to EQ-5D and SF36.…”

Section: Discussionsupporting

confidence: 91%

“…Many published studies have revealed improvements in the health-related QOL of patients with CHD after CR programs, either the residential model or ambulatory CR (ACR). [12][13][14][15][16][17][18][19][20][21][22][23] The aim of this study was to evaluate the impact of different models of CR, residential vs ambulatory, on healthrelated QOL according to the exercise capacity of patients with CHD. …”

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confidence: 99%

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Health-Related Quality of Life in Patients With Coronary Heart Disease After Residential vs Ambulatory Cardiac Rehabilitation

Jegier¹,

Szmigielska²,

Bilińska³

et al. 2009

Circ J

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he number of people who survive myocardial infarction or undergo percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) is growing. These people require adequate treatment and care not only pharmacologically but also nonpharmacologically: physiotherapeutic, psychological and educational. Comprehensive cardiac rehabilitation (CR) is designed to support patients with coronary heart disease (CHD) in their physical, psychological and emotional recovery after acute coronary events and to help them change lifestyle and risk factors, as well as to make their lives longer and improve their quality.Most published studies analyzing the effects of CR have revealed a reduction in total mortality by an average of 30% and cardiovascular mortality by an average of 40% [1][2][3][4][5][6][7][8][9][10] and also reduction in cardiovascular events risk. 1,4,11 Recently, not only mortality and morbidity but also healthrelated quality of life (QOL) has become a key goal for patients with CHD. Many published studies have revealed improvements in the health-related QOL of patients with CHD after CR programs, either the residential model or ambulatory CR (ACR). [12][13][14][15][16][17][18][19][20][21][22][23] The aim of this study was to evaluate the impact of different models of CR, residential vs ambulatory, on healthrelated QOL according to the exercise capacity of patients with CHD. MethodsThis study was designed as a nonrandomized prospective multicenter study in Poland: the National Program of Prevention and Therapy of Cardiovascular Diseases (POLKARD). We studied 562 patients with CHD from 9 centers of CR in Poland. Consecutive patients were referred to 3 ACR and 6 residential CR (RCR) centers no longer than 2 weeks after myocardial infarction or PCI, and no longer than 6 weeks after CABG.The reason for the choice of ACR or RCR center was not the patient's clinical state or risk profile for cardiovascular events, but which type of CR was available where the patient lived. Therefore, randomization in our study was impossible.The first group consisted of 313 patients aged 56.1±8.8 (Received April 24, 2008; revised manuscript received October 8, 2008; accepted October 26, 2008; released online January 29, 2009) Background: The aim of this study was to evaluate the influence of residential (RCR) vs ambulatory (ACR) cardiac rehabilitation (CR) on health-related quality of life (QOL) connected with changes in exercise capacity of patients with coronary heart disease (CHD). Methods and Results:The 562 patients with CHD were studied: 313 participants in RCR and 249 participants in ACR. The examination was performed at the beginning of CR and after 8 weeks. QOL was assessed using the EuroQuol 5D (EQ-5D) and SF36 questionnaires. Exercise testing was performed with evaluation of workload during the last stage of the test and rate of perceived exertion intensity. In the first examination, patients from both groups did not differ significantly. After 8 weeks, a similar improvement in QOL was observed in bo...

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Health-Related Quality of Life in Patients With Coronary Heart Disease After Residential vs Ambulatory Cardiac Rehabilitation

Jegier¹,

Szmigielska²,

Bilińska³

et al. 2009

Circ J

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“…This is a rather small number of patients and sickness absence will be included as a measure when evaluating employment status. The direct costs of healthcare are calculated by a retrospective top-down method [44]. All other costs are extracted from relevant registers.…”

Section: Methodsmentioning

confidence: 99%

COPE-ICD: A randomised clinical trial studying the effects and meaning of a comprehensive rehabilitation programme for ICD recipients -design, intervention and population

Berg

Svendsen

Zwisler

et al. 2011

BMC Cardiovasc Disord

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BackgroundGrowing evidence exists that living with an ICD can lead to fear and avoidance behaviour including the avoidance of physical activity. It has been suggested that psychological stress can increase the risk of shock and predict death. Small studies have indicated a beneficial effect arising from exercise training and psychological intervention, therefore a large-scale rehabilitation programme was set up.Methods/DesignA mixed methods embedded experimental design was chosen to include both quantitative and qualitative measures. A randomised clinical trial is its primary component. 196 patients (power-calculated) were block randomised to either a control group or intervention group at a single centre. The intervention consists of a 1-year psycho-educational component provided by two nurses and a 12-week exercise training component provided by two physiotherapists. Our hypothesis is that the COPE-ICD programme will reduce avoidance behaviour, sexual dysfunction and increase quality of life, increase physical capability, reduce the number of treatment-demanding arrhythmias, reduce mortality and acute re-hospitalisation, reduce sickness leading to absence from work and be cost-effective. A blinded investigator will perform all physical tests and data collection.DiscussionMost participants are men (79%) with a mean age of 58 (range 20-85). Most ICD implantations are on primary prophylactic indication (66%). 44% is NYHA II. Mean walk capacity (6MWT) is 417 m. Mean perception of General Health (SF-36) is PCS 42.6 and MCS 47.1.A large-scale ICD rehabilitation trial including psycho-educational intervention and exercise training has been initiated and will report findings starting in 2011.Trial RegistrationClinicalTrials.gov: NCT00569478

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“…Several studies using the EQ-5D questionnaire to assess QOL among patients with coronary heart disease have been conducted (7)(8)(9)(10)(11), but only a few of them have used it in the subset of patients with ACS (12,13). The MERLIN-TIMI 36 Randomized trial of Ranolazine versus placebo had been carried out in 6560 patients with non-STelevation ACS reported an EQ-5D questionnaire single index value of approximately 0.71 at baseline and 0.84 at 12 months.…”

Section: Discussion:-mentioning

confidence: 99%

Clinical Outcomes and Quality of Life in Patients With Acs Treated With Concomitant Use of Ticagrelor and Clopidogrel.

Kopaleishvil¹,

Jashi²

2017

IJAR

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Comprehensive cardiac rehabilitation: A cost assessment based on a randomized clinical trial

Abstract: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective.

Cited by 8 publications

References 4 publications

Health-Related Quality of Life in Patients With Coronary Heart Disease After Residential vs Ambulatory Cardiac Rehabilitation

Health-Related Quality of Life in Patients With Coronary Heart Disease After Residential vs Ambulatory Cardiac Rehabilitation

COPE-ICD: A randomised clinical trial studying the effects and meaning of a comprehensive rehabilitation programme for ICD recipients -design, intervention and population

Clinical Outcomes and Quality of Life in Patients With Acs Treated With Concomitant Use of Ticagrelor and Clopidogrel.

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