Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial.

Abstract

BACKGROUND:

Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic era of cardiology.

METHODS:

We conducted a centrally randomized single-center clinical trial with blinded assessment of the primary outcome: registry-based composite of total mortality, myocardial infarction, or acute first-time readmission due to heart disease. Other outcomes were hospitalization, risk profile, and quality of life. The trial included 770 participants (20-94 years) with congestive heart failure (12%), ischemic heart disease (58%), or high risk of ischemic heart disease (30%). Comprehensive cardiac rehabilitation is composed of 6 weeks of intensive intervention and systematic follow-up for 10.5 months.

RESULTS:

We randomized 380 patients to CCR versus 390 to UC. Randomization was well balanced. The primary outcome occurred in 31% of both groups (relative risk 0.96, 95% confidence interval 0.78-1.26). Compared with the UC group, CCR significantly reduced length of stay by 15% (95% confidence interval 1.1%-27.1%, P = .04), mean number of cardiac risk factors above target (4.5 vs 4.1, P = .01), patients with systolic blood pressure below target (P = .003), physically inactivity (P = .01), and unhealthy dietary habits (P = .0003). Short-Form-36 and Hospital Anxiety and Depression Scale did not differ significantly.

CONCLUSION:

At 12 months, the CCR and UC groups did not differ regarding the primary composite outcome. Comprehensive cardiac rehabilitation significantly reduced length of hospital stay and improved cardiac risk factors.

• Authors: Ann-Dorthe Olsen Zwisler, Anne Merete Boas Soja, Søren Rasmussen, Marianne Frederiksen, Sadollah Abedini, Sadollah Abadini, Jon Appel, Hanne Rasmussen, Christian Gluud, Lars Iversen, Bjarne Sigurd, Mette Madsen, Jørgen Fischer-Hansen, DANREHAB Group
• Journal: American heart journal (Am Heart J) Vol. 155 Issue 6 Pg. 1106-13 (Jun 2008) ISSN: 1097-6744 [Electronic] United States
• PMID: 18513526 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Heart Failure (rehabilitation)
• Hospitalization
• Humans
• Male
• Middle Aged
• Myocardial Ischemia (rehabilitation)
• Risk Factors
• Severity of Illness Index