Cost-Effectiveness of Cardiac Rehabilitation After Myocardial Infarction

Ades, Philip A.; Pashkow, Fredric J.; Nestor, James R.

doi:10.1097/00008483-199609000-00015

Cited by 33 publications

(55 citation statements)

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“…For example, smoking cessation among CHD patients is associated with a 40% or larger reduction in mortality (Wilson, Gibson, Willan, & Cook, 2000), and its cost effectiveness compares favorably with standard medical treatments (e.g., thrombolytic therapy, cholesterol lowering medication) and behavioral approaches to rehabilitation (e.g., exercise; Ades, Pashkow, & Nestor, 1997). Hence, these interventions should be a priority among smokers with CHD.…”

Section: Implications For Patient Carementioning

confidence: 99%

“…Hence, these interventions should be a priority among smokers with CHD. Exercise interventions reduce cardiac recurrences and death, and they also compare favorably to medical approaches in cost-effectiveness analyses (Ades et al, 1997). Further, exercise interventions can reduce hypertension and depressive symptoms Blumenthal et al, 1999) and have been found to increase heart rate variability among CHD patients (Stahle, Nordlander, & Bergfeldt, 1999).…”

Section: Implications For Patient Carementioning

confidence: 99%

See 1 more Smart Citation

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Smith¹,

Ruiz²

2002

Journal of Consulting and Clinical Psychology

292

208

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Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research.Coronary heart disease (CHD) is the leading cause of death in the United States; each year about 450,000 people die from CHD, and 1,000,000 experience an initial or recurrent coronary event (American Heart Association, 2001). Among healthy 40-year olds, between 40% and 50% of men and between 25% and 35% of women will later develop CHD (Lloyd-Jones, Larson, Beiser, & Levy, 1999). Over $100 billion is spent on CHD each year in the United States in direct medical costs, disability payments, and lost productivity (American Heart Association, 2001). This disease involves the three major topics composing behavioral medicine and health psychology, making it a central focus throughout their 30-year history. In the first (i.e., health behavior and prevention), modifiable behavioral risk factors (e.g., smoking, activity level, diet) are important risk factors for the development of CHD (Stamler et al., 1999;Wannamethee, Shaper, Walker, & Ebrahim, 1998), and behavior change is an essential component of prevention. In the second topic (i.e., stress and disease or psychosomatics), other psychological and social factors have more direct effects on the development and course of CHD through the intervening psychobiological effects of stress and negative emotions. In the third (i.e., psychosocial aspects of medical illness and care), established CHD has extensive emotional and social impacts on patients and their families, behavior is a key element of standard care (e.g., medication adherence, dietary change, exercise), and psychosocial interventions are useful additions to traditional medical and surgical treatment.Like the article on CHD in the previous special issue on behavioral medicine in this journal (Thoresen & Powell, 1992), we focused primarily on the second major topic-psychosocial influences on the development and course of CHD. We also reviewed one aspect of the third topic-interventions targeting psychosocial risk factors and their underlying psychophysiological mechanisms. Perhaps the most important implication of research on psychosocial risk factors for coronary disease is that interventions targeting these factors could reduce cardiac morb...

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Section: Implications For Patient Carementioning

confidence: 99%

Section: Implications For Patient Carementioning

confidence: 99%

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Smith¹,

Ruiz²

2002

Journal of Consulting and Clinical Psychology

292

208

View full text Add to dashboard Cite

show abstract

“…Merely the emergency service frequency use in CR group was significantly lo wer than CG at the end of 18 months follow-up. This perceptible contrast with the studies mentioned above may be caused by the small sample, as demonstrated by others [29].Nonetheless, hospitalization reduction as well as emergency services can favorably affect costs in HF treatment, emphasizing CR treatment [2,5,6,7,10,23,24].…”

Section: Hos Pital Admission and Mortalitymentioning

confidence: 95%

“…In general, supervised CR programs are successful in increasing physical fitness, cardiovascular performance, quality of life and reducing mortality [5][6][7][8][9][10][11][12][13][19][20][21][22][23][24].However, there are indicat ions that only 11% to 30% of those who need CR have access to specialized centers [6,22,23,25].Taking these facts into consideration, there has been an increase in the number of programs, whether supervised or not. The effectiveness of these programs has been well documented, revealing broad benefits [19,23,[26][27][28],although other studies have failed to observe positive effects, especially those regarding quality of life [29].In the present study, patients with HF in both groups demonstrated improvement in cardio respiratory fitness and in functional capacity during the 60 intervention days, as verified by other authors [19][20][21]23,[26][27][28].Nevertheless, only the supervised CR group showed quality of life imp rovement along the 60 CR days.…”

Section: Supervised Program Effectsmentioning

confidence: 99%

Quality of Life after Cardiac Rehabilitation for Patients with Heart Failure: 18 months follow-up

Pôrto¹,

Kümpel²,

Leite³

et al. 2012

AJMMS

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The aim of this study was to evaluate the effects of a supervised cardiac rehabilitation (CR) program on longterm quality of life (Qo L) of patients with heart failure (HF).Methods: A sample of 21 HF patients, previously sedentary, NYHA II, was randomly divided into two g roups: the CR group (N = 13) and the control group (CG = 8). The CR consisted of sessions of 120 minutes/day, 3 times/week,for 60 days. CR g roup performed their activ ities under supervision at a rehabilitation clinic, and CG received standard care and was instructed to exercise at ho me. All patients underwent a ma xima l sympto m-limited test at the beginning and after 30 and 60 days of CR. Qo L was monitored after 60-days, 6, 12 and 18 months of CR. Results:Two-way A NOVA for repeated measures, follo wed by Tukey's test for statistical analysis showed significantimp rovement in peak VO 2 at 30 and 60-days of CR (p<0.05). Qo L imp roved after 60-days of CR and remained improved throughout the 18following months in the supervised CR group. The use of hospital emergency services became less frequent (p=0.023) and there was a trend for better survival after 18 months of follow-up (p=0.092).Conclusion: CR was effect ive upon cardiopulmonary and Qo L aspects.

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“…Because of the bias of each countries health system, it is hard to generalize results to all, but CR programs usually have no effect or reduce total costs, with some studies showing that CR can be even cost saving, because it not only decreases costs but also increases survival. Ades et al 36 analyzed the cost/benefit ratio of 21 months of CR, and found savings of USD 739 and Oldrige et al 37 evidenced savings of USD 9,200, over a period of 12 months in comparison with the control group.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Untitled

2017

IPMRJ

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Cardiovascular diseases are the leading cause of death and an important cause of morbidity. Cardiac rehabilitation is a major part of secondary prevention for patients with coronary heart disease with several benefits across its spectrum, including reductions in mortality, cardiac events and improvement in quality of life, among patients after myocardial infarction percutaneous coronary intervention and coronary artery bypass graft. This review sought to present several evidence-based benefits of cardiac rehabilitation in the coronary heart disease scenarios of secondary prevention.

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Cost-Effectiveness of Cardiac Rehabilitation After Myocardial Infarction

Cited by 33 publications

References 0 publications

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Quality of Life after Cardiac Rehabilitation for Patients with Heart Failure: 18 months follow-up

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