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
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
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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.