Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases

Abstract

Background:Cardiac rehabilitation (CR) programmes have been shown to improve patient outcomes, but vary widely in their components. The impact of Singapore’s CR programme on clinical outcomes is currently not known.Objective:To evaluate the effects of a community-based CR programme on important clinical parameters in patients with cardiovascular disease in Singapore.Method:A retrospective cohort study was conducted. Cardiovascular patients who had completed a hospital-based CR programme were included. Patients who continued with community-based CR (n = 94) during the period of 2009-2013 were compared with patients who received regular care (n = 157). Changes in clinical and physical examination parameters between baseline and one-year post follow-up were analyzed. Within-group differences were compared using the paired t-test, while multivariate linear regression was used to compare the changes in the various parameters between the intervention and control groups. The primary outcome measure was low density lipoprotein (LDL) levels.Results:Patients in the intervention group had significant lowering of LDL (2.5 to 2.2 mmol/L, p<0.01), while the control group’s LDL increased (2.2 to 2.4 mmol/L, p<0.01). The intervention group had greater improvements in LDL (-0.3 vs. +0.2 mmol/L, p<0.01), triglycerides (-0.1 vs. +0.1 mmol/L, p=0.01), total cholesterol (-0.3 vs. +0.3 mmol/L, p<0.01), fasting blood glucose (-0.5 vs. +0.3 mmol/L, p<0.01), systolic blood pressure (-3.2 vs. +5 mmHg, p<0.01) and diastolic blood pressure (-2.6 vs. +2.8 mmHg, p<0.01).Conclusion:The community-based CR programme in Singapore is associated with improvements in several cardiovascular clinical parameters and may be of benefit to cardiovascular patients.

Features

“…Compared to those patients who received usual care, these patients were found to have an overall improvement of 12% in "bad" cholesterol, 7.8% triglycerides, 7% total cholesterol, 8.2% fasting blood glucose, 2.5% systolic BP and 3.5% diastolic BP after one year of community rehabilitation [2].…”

Asian Pacific Society of Cardiology Consensus Statements on the Diagnosis and Management of Chronic Heart Failure

“…Community-based rehabilitation programmes may help improve the accessibility of and compliance with cardiac rehabilitation in HF patients in the Asia-Pacific region and are associated with favourable CV health benefits, including improved CV markers. 59,60 CIED therapy for HF includes the implantable cardioverter defibrillator and cardiac resynchronisation therapy. Randomised trials have demonstrated that the use of CIEDs in carefully selected patients reduces the risk of death across a relatively wide range of clinical scenarios.…”

‘The illness isn’t the end of the road’—Patient perspectives on the initiation of and early participation in a multi-disease, community-based exercise programme

“…Uptake to maintenance CBCR programmes is hindered by the inadequate availability of such services [23,24] with the majority of these programmes delivered by HCPs such as physiotherapists [25,26], GPs [27] or a multidisciplinary team including cardiologists, physiotherapist, CR nurses and exercise physiologists [16,28]. Traditionally long-term exercise programmes have been delivered for individual CDs such as CR and pulmonary rehabilitation.…”