A short course of cardiac rehabilitation program is highly cost effective in improving long-term quality of life in patients with recent myocardial infarction or percutaneous coronary intervention

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Abstract

Yu C-M, Lau C-P, Chau J, McGhee S, Kong S-L, Cheung BM-Y, Li LS-W. A short course of cardiac rehabilitation program is highly cost effective in improving long-term quality of life in patients with recent myocardial infarction or percutaneous coronary intervention.

Objective

To evaluate the long-term effect of a cardiac rehabilitation and prevention program (CRPP) on quality of life (QOL) and its cost effectiveness.

Design

Prospective, randomized controlled trial.

Setting

University-affiliated outpatient cardiac rehabilitation and prevention center.

Participants

A total of 269 patients (76% men; mean age, 64±11y) with recent acute myocardial infarction (AMI; n=193) or after elective percutaneous coronary intervention (PCI; n=76) were randomized in a ratio of 2 to 1.

Intervention

Patients received either CRPP (an 8-wk exercise and education class in phase 2) or conventional therapy without exercise program (control group). They were followed until they had completed all 4 phases of the program (ie, 2y).

Main outcome measures

QOL assessments, by using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Symptoms Questionnaire, were performed at the end of each phase. Direct health care cost was calculated, whereas cost utility was estimated as money spent (in US$) per quality-adjusted life-year (QALY) gained.

Results

In the CRPP group, 6 of the 8 SF-36 dimensions improved significantly by phase 2 and were maintained throughout the study period. Patients were less anxious and depressed, and felt more relaxed and contented. In the control group, none of the SF-36 dimensions were improved by phase 2, and bodily pain was increased. In phase 4, only 4 dimensions were improved. Symptoms were unchanged except for increased hostility score. There was a significant gain in net time trade-off in the CRPP group after phase 2. The direct health care expenses in the CRPP and control groups were $15,292 and $15,707 per patient, respectively. Therefore, the cost utility calculated was $640 saved per QALY gained. Savings attributable to CRPP were primarily explained by the lower rate (13% vs 26% of patients, χ2 test=3.9, P<.05) and cost of subsequent PCI (P=.01).

Conclusions

In an era of managing patients with coronary heart disease, a short-course CRPP was highly cost effective in providing better QOL to patients with recent AMI or after elective PCI. In addition, the improvement of QOL was quick and sustained for at least 2 years after CRPP.

Section snippets

Setting and patients

This unblinded RCT included 269 consecutive patients who were referred to a university-affiliated cardiac rehabilitation center. The largest rehabilitation facility in Hong Kong, this center is situated in the west of the Hong Kong Island and serves a population of about half a million. All patients recruited were either transferred from regional hospitals or attended the outpatient cardiac clinic. Once they were received in the rehabilitation center, consecutive patients within 6 weeks of an

Patient characteristics

Of the 269 Chinese patients recruited, 193 were recruited after recent AMI and 76 after elective PCI (fig 1). The mean age was 64±11 years, and 204 (76%) were men. One hundred eighty-one patients were randomized into the CRPP group and 88 into the control group. There was no difference in age, sex, and other clinical parameters between the CRPP and control groups (table 1). In the CRPP group, 40% of patients were current smokers, 46% had hypertension, 27% had diabetes, and 47% had a history of

Long-term improvement of QOL by CRPP

Early studies5, 21, 23, 24, 25 of CRPP based on small patient number and nonrandomized or uncontrolled trials reported that QOL was improved in both young and elderly subjects with recent AMI.23, 24, 25 Although the use of questionnaires to assess HRQOL in patients with coronary heart disease has been validated in large populations,19 the improvement in psychologic aspects cannot be confidently attributed to CRPP itself, because patients not undergoing CRPP may also have gradual recovery of

Conclusions

This RCT found that patients with AMI or after elective PCI who underwent an 8-week course of CRPP had early and sustained improvement in QOL for at least 2 years. CRPP was highly cost effective, with a net gain in QALY, whereas direct health care expenses were reduced, which was primarily related to the reduction of the subsequent need for PCI. The information provided in this study supports the adoption of CRPP in addition to the contemporary regimen of managing patients with coronary heart

References (35)

  • P. Abete et al.

    Exercise training restores ischemic preconditioning in the aging heart

    J Am Coll Cardiol

    (2000)
  • G.J. Balady et al.

    Core components of cardiac rehabilitation/secondary prevention programsa statement for healthcare professionals from the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation Writing Group

    Circulation

    (2000)
  • M.L. Pollock et al.

    Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position paper endorsed by the American College of Sports Medicine

    Circulation

    (2000)
  • N.B. Oldridge et al.

    Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials

    JAMA

    (1988)
  • D.R. Packa et al.

    Quality of life of elderly patients enrolled in cardiac rehabilitation

    J Cardiovasc Nurs

    (1989)
  • N.B. Oldridge

    Outcome assessment in cardiac rehabilitation. Health-related quality of life and economic evaluation

    J Cardiopulm Rehabil

    (1997)
  • P. Wahrborg

    Quality of life after coronary angioplasty or bypass surgery. 1-year follow-up in the Coronary Angioplasty versus Bypass Revascularization investigation (CABRI) trial

    Eur Heart J

    (1999)
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    Supported by the Health Care & Promotion Fund Committee of Hong Kong (grant no. 511022).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

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