LC-REHAB: randomised trial assessing the effect of a new patient education method - learning and coping strategies – in cardiac rehabilitation Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring. Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment The Effects of a Collaborative Peer Advisor/Advanced Practice Nurse Intervention: Cardiac Rehabilitation Participation and Rehospitalization in Older Adults After a Cardiac Event Cardiac rehabilitation after myocardial infarction. Designing a theory- and evidence-based tailored eHealth rehabilitation aftercare program in Germany and the Netherlands: study protocol The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial. Comparing multifactorial lifestyle interventions and stress management in coronary risk reduction The cardiac model of rehabilitation for reducing cardiovascular risk factors post transient ischaemic attack and stroke: a randomized controlled trial E-Rehabilitation – an Internet and mobile phone based tailored intervention to enhance self-management of Cardiovascular Disease: study protocol for a randomized controlled trial Comparative outcome one year after formal cardiac rehabilitation: the effects of a randomized intervention to improve exercise adherence Psychological Morbidity after Myocardial Infarction in an Area of Deprivation in the UK: Evaluation of a Self-Help Package Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. Evaluation of a home-based rehabilitation programme for patients recovering from acute myocardial infarction. A randomised 2 x 2 trial of community versus hospital pulmonary rehabilitation, followed by telephone or conventional follow-up.
Background Due to improved treatments and ageing population , many countries now report increasing prevalence in rates of ischemic heart disease and heart failure . Cardiac rehabilitation has potential to reduce morbidity and mortality , but not all patients complete . In light of favourable effects of cardiac rehabilitation it is important to develop patient education methods which can enhance adherence to this effective program . The LC-REHAB study aims to compare the effect of a new patient education strategy in cardiac rehabilitation called ‘ learning and coping ’ to that of st and ard care . Further , this paper aims to describe the theoretical basis and details of this intervention . Methods / design Open parallel r and omised controlled trial conducted in three hospital units in Denmark among patients recently discharged with ischemic heart disease or heart failure . Patients are allocated to either the intervention group with learning and coping strategies incorporated into st and ard care in cardiac rehabilitation or the control group who receive the usual cardiac rehabilitation program . Learning and coping consists of two individual clarifying interviews , participation of experienced patients as educators together with health professionals and theory based , situated and inductive teaching . Usual care in cardiac rehabilitation is characterised by a structured deductive teaching style with use of identical pre-written slides in all hospital units . In both groups , cardiac rehabilitation consists of training three times a week and education once a week over eight weeks . The primary outcomes are adherence to cardiac rehabilitation , morbidity and mortality , while secondary outcomes are quality of life ( SF-12 , Health education impact question naire and Major Depression Inventory ) and lifestyle and risk factors ( Body Mass Index , waist circumference , blood pressure , exercise work capacity , lipid profile and DXA-scan ) . Data collection occurs four times ; at baseline , at immediate completion of cardiac rehabilitation , and at three months and three years after the finished program . Discussion It is expected that learning and coping incorporated in cardiac rehabilitation will improve adherence in cardiac rehabilitation and may decrease morbidity and mortality . By describing learning and coping strategies the study aims to provide knowledge that can contribute to an increased transparency in patient education in cardiac rehabilitation . Trial registration Identifier NCT01668394 Objective : To investigate the long-term effect of exp and ed cardiac rehabilitation on a composite end-point , consisting of cardiovascular death , myocardial infa rct ion or readmission for cardiovascular disease , in patients with coronary artery disease . Design : Single-centre prospect i ve r and omized controlled trial . Setting : University hospital . Subjects : Two hundred and twenty-four patients with acute myocardial infa rct ion or undergoing coronary artery by-pass grafting . Intervention : Patients were r and omized to exp and ed cardiac rehabilitation ( a one-year stress management programme , increased physical training , staying at a ‘ patient hotel ’ for five days after the event , and cooking sessions ) , or to st and ard cardiac rehabilitation . Main measures : Data on cardiovascular death , myocardial infa rct ion , readmission for cardiovascular disease and days at hospital for cardiovascular reasons were obtained from national registries of the Swedish National Board of Health and Welfare . Results : The primary end-point occurred in 121 patients altogether ( 54 % ) . The number of cardiovascular events were reduced in the exp and ed rehabilitation group compared with the st and ard cardiac rehabilitation ( 53 patients ( 47.7 % ) versus 68 patients ( 60.2 % ) ; hazard ratio 0.69 ; P = 0.049 ) . This was mainly because of a reduction of myocardial infa rct ions in the exp and ed rehabilitation group . During the five years 12 patients ( 10.8 % ) versus 23 patients ( 20.3 % ) ; hazard ratio 0.47 ; P = 0.047 had a myocardial infa rct ion . Days at hospital for cardiovascular reasons were significantly reduced in patients who received exp and ed cardiac rehabilitation ( median 6 days ) compared with st and ard cardiac rehabilitation ( median 10 days ; P = 0.02 ) . Conclusion : Exp and ed cardiac rehabilitation after acute myocardial infa rct ion or coronary artery bypass grafting reduces cardiovascular morbidity and days at hospital for cardiovascular reasons OBJECTIVE The goal of this study was to compare the effectiveness of home-based , transtelephonically monitored cardiac rehabilitation with  st and ard , on-site , supervised cardiac rehabilitation . BACKGROUND Participation in cardiac rehabilitation has been demonstrated to increase exercise capacity , decrease cardiovascular symptoms , improve psychosocial status , and decrease total and cardiovascular mortality rates in patients with coronary heart disease . Because of multiple factors , national overall participation is only at 15 % of eligible patients . METHODS Effects of a 3-month home-based , transtelephonically monitored rehabilitation program ( n = 83 patients ) with simultaneous voice and electrocardiographic transmission to a central ly located nurse coordinator were compared with effects of a st and ard on-site rehabilitation program ( n = 50 patients ) . The study design was a multicenter , controlled trial . Primary outcome variables were peak aerobic capacity and quality of life , as measured by the Health Status Question naire . RESULTS Patients in the home-based monitoring program increased peak aerobic capacity to a similar degree as patients who exercised on site ( 18 % vs 23 % ) . Quality of life domains of physical functioning , social functioning , physical role limitations , emotional role limitations , bodily pain , and energy/fatigue improved similarly in both groups . There were no circulatory arrests or other major exercise-related medical events in either group . A total of 3100 hours of home exercise were transtelephonically monitored . CONCLUSIONS Patients with coronary heart disease can effectively participate in home-based , monitored cardiac rehabilitation , with exercise and quality of life improvements comparable to those demonstrated at on-site programs Background : Short hospital stays for patients with acute coronary syndromes ( ACSs ) reduce the opportunity for risk factor intervention during admission . After discharge , cardiac rehabilitation can decrease the recurrence of coronary events by up to 25 % . However , it remains underused . Objectives : The aim of this study was to determine whether a nursing intervention focused on individual ACS patients ’ perceptions of their disease and treatment would increase rehabilitation enrollment after discharge . Method : A total of 242 ACS patients admitted to a specialized tertiary cardiac center were r and omized to either the intervention or  usual care  ( n = 121 in both groups ) . The intervention included one nurse – patient meeting before discharge with 2 additional contacts over the 10 days after discharge ( mean duration = 40 minutes per contact ) . The primary outcome was enrollment in a free rehabilitation program offered to all participants 6 weeks after discharge . Secondary outcomes included illness perceptions ; family support ; anxiety level ; medication adherence ; and cardiac risk factors including lack of exercise , smoking , body mass index , and diet . Results : The sample was composed of a majority of male , married workers who experienced a myocardial infa rct ion or unstable angina without severe complications . The mean hospital stay in both groups was 3.6 days . There was a significantly higher rate of rehabilitation enrollment in the intervention group ( 45 % ) than in the control group ( 24 % ; p = .001 ) . For the secondary outcomes , only the personal control dimension of illness perceptions was improved significantly with the intervention . Discussion : Progressive , individualized interventions by nurses result ed in greater rehabilitation enrollment , thereby potentially improving long-term outcome Background : After the cardiovascular events of myocardial infa rct ion ( MI ) and coronary artery bypass surgery ( CABS ) , unpartnered older adults are a vulnerable group that may benefit from interventions to improve health outcomes . The purpose of this analysis is to determine if a community-based collaborative peer advisor/advanced practice nurse intervention increased participation in cardiac rehabilitation programs and reduced hospital readmissions after MI and CABS and determine whether the type of cardiovascular event influenced rehospitalization . Subjects and Methods : This study was a r and omized clinical trial that enrolled 247 unpartnered older adults who were single , widowed , or divorced . Subjects were r and omized into 4 groups : st and ard of care group for MI and for CABS and st and ard of care plus the treatment groups for MI and for CABS , for 12 weeks after discharge . There were 163 women/84 men , with a mean age of 76.4 years , who were admitted for MI ( n = 93 ) or CABS ( n = 154 ) and who were enrolled from 5 academic medical centers . The treatment consisted of a community-based intervention of a home visit within 72 hours and telephone calls at 2 , 6 , and 10 weeks from an advanced practice nurse and 12 weekly telephone calls from a peer advisor .  Participation in a cardiac rehabilitation program and rehospitalizations were collected at 6 weeks and 3 , 6 , and 12 months by telephone interview . Results and Conclusions : There were significantly more participants in cardiac rehabilitation programs after 3 months in the treatment group , and this increase was seen up to 1 year after MI and CABS . There were no statistical differences , although there were fewer rehospitalizations between 3 and 6 months after MI and CABS in the treatment group compared with the st and ard of care group . Overall , the evidence from this study suggests that a community-based collaborative peer advisor/advanced practice nurse intervention can play a role in promoting active participation in cardiac rehabilitation programs and fewer rehospitalizations in unpartnered older adults after MI and CAGS Cardiac rehabilitation/ secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease ( CHD ) , and as such are recommended as useful and effective ( Class I ) by the American Heart Association and the American College of Cardiology in the treatment of patients with CHD . The term cardiac rehabilitation refers to coordinated , multifaceted interventions design ed to optimize a cardiac patient 's physical , psychological , and social functioning , in addition to stabilizing , slowing , or even reversing the progression of the underlying atherosclerotic processes , thereby reducing morbidity and mortality . Cardiac rehabilitation , aims at returning the patient back to normal functioning in a safe and effective manner and to enhance the psychosocial and vocational state of the patient . The program involves education , exercise , risk factor modification and counselling . A meta- analysis based on a review of 48 r and omized trials that compared outcomes of exercise-based rehabilitation with usual medical care , showed a reduction of 20 % in total mortality and 26 % in cardiac mortality rates , with exercise-based rehabilitation compared with usual medical care . Risk stratification helps identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants . During exercise , the patients ' ECG is continuously monitored through telemetry , which serves to optimize the exercise prescription and enhance safety . The safety of cardiac rehabilitation exercise programs is well established , and the occurrence of major cardiovascular events during supervised exercise is extremely low . As hospital stays decrease , cardiac rehabilitation is assuming an increasingly important role in secondary prevention . In contrast with its growing importance internationally , there are very few cardiac rehabilitation centers in India at the present moment Background Cardiac rehabilitation programs aim to improve health status and to decrease the risk of further cardiac events .  Persons undergoing rehabilitation often have difficulties transferring the learned health behaviors into their daily routine after returning home and maybe to work . This includes physical activity as well as fruit and vegetable consumption . Computer-based tailored interventions have been shown to be effective in increasing physical activity as well as fruit and vegetable consumption . The aim of this study is , to support people in transferring these two learned behavior changes and their antecedents into their daily life after cardiac rehabilitation . Methods The study will have a r and omized controlled design and will be conducted among German and Dutch people who participated in cardiac rehabilitation . The study will consist of one intervention group which will be compared to a waiting list control group . During the eight week duration of the intervention , participants will be invited to participate in the online after-care program once per week . The intervention encourages participants to define individual health behavior goals as well as action , and coping plans to reach these self-determined goals . The effectiveness of the program will be compared between the intervention condition and the control group in terms of behavior change , antecedents of behavior change ( e.g. , self-efficacy ) , ability to return to work and increased well-being . Further , subgroup-differences will be assessed including differences between the two countries , socioeconomic inequalities and across age groups . Discussion The present study will make a contribution to underst and ing how such an online-based tailored interventions enables study participants to adopt and maintain a healthy lifestyle . Implication s can include how such an online program could enrich cardiac rehabilitation aftercare further . Trial registration NTR 3706 , Background Cardiac rehabilitation has a beneficial effect on the prognosis and quality of life of cardiac patients , and has been found to be cost-effective . This report describes a comprehensive and low cost educational intervention design ed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery . Methods / Design A controlled prospect i ve intervention trial . The control arm comprised 520 patients who underwent coronary artery bypass graft surgery between January 2004 and May 2005 in five medical centers across Israel . This group received no additional treatment beyond usual care . The intervention arm comprised 504 patients recruited from the same cardiothoracic departments between June 2005 and November 2006 . This group received oral and written explanations about the advantages of participating in cardiac rehabilitation programs and a telephone call two weeks after hospital discharge intended to further encourage their enrollment . The medical staff attended a one-hour seminar on cardiac rehabilitation . In addition , it was recommended that referral to cardiac rehabilitation be added to the letter of discharge from the hospital . Both study groups were interviewed before surgery and one-year post surgery . A one-year post-operative interview assessed factors affecting patient attendance at cardiac rehabilitation programs , as well as the structure and content of the cardiac rehabilitation programs attended . Anthropometric parameters were measured at pre- and post-operative interviews;- and medical information was obtained from patient medical records . The effect of cardiac rehabilitation on one- and three-year mortality was assessed . Discussion We report a low cost yet comprehensive intervention design ed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation . Trial registration Clinical Trials.gov : OBJECTIVE To estimate the incremental effects on cost and quality of life of  cardiac rehabilitation after an acute coronary syndrome . DESIGN Open r and omised controlled trial with 1 year 's follow-up . Analysis was on an intention-to-treat basis . SETTING Two tertiary hospitals in Sydney . INTERVENTION 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor . PARTICIPANTS 113 patients aged 41 - 75 years who were self-caring and literate in English . Patients with uncompensated heart failure , uncontrolled arrhythmias , severe and symptomatic aortic stenosis or physical impairment were excluded . MAIN OUTCOME MEASURES Costs ( hospitalisations , medication use , outpatient visits , investigations , and personal expenses ) ; and measures of quality of life . Incremental cost per quality -adjusted life year ( QALY ) saved at 1 year ( this estimate combines within- study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality ) . Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival , 3 years of treatment effect on survival and variations in utility . RESULTS The estimated incremental cost per QALY saved for  rehabilitation  relative to st and ard care was 42,535 US dollars when modelling included the reported treatment effect on survival . This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included . The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective . CONCLUSIONS The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome . The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee The aim of this study was to compare the effects of residential multifactorial cardiac rehabilitation , outpatient multifactorial rehabilitation , stress management , and st and ard coronary rehabilitation , on cardiac risk reduction . Out of 144 eligible male patients recently treated with percantaneous transluminal coronary angiography ( PTCA ) , coronary artery bypass graft ( CABG ) , or acute myocardial infa rct ion ( AMI ) , 132 were r and omized into this study . All interventions covered a 12-month active intervention , intense during the first months and subsequently leveled out . Main assessment s were performed before r and omization and after the intervention . Patients offered behavioral rehabilitation showed improved selfreported healthy diet habits and exercise frequency , and higher internal locus of control . Although blood lipids , exercise capacity , body mass , anxiety , depression , and Type A scores were changed in the expected direction , no significant difference emerged between active intervention and the st and ard care condition . St and ard care of today appears to have great potential in particular if supplemented with some kind of stress management Objective : To evaluate the feasibility and effectiveness of a st and ard National Health Service cardiac rehabilitation programme on risk factor reduction for patients after a minor stroke and transient ischaemic attack . Design : Single-blind r and omized controlled trial . Setting : Cardiac rehabilitation classes . Subjects : Twenty-four patients . Intervention : All participants received st and ard care . In addition , the intervention group undertook an eight-week cardiac rehabilitation programme consisting of weekly exercise and education classes . Outcome measures : Cardiovascular disease risk score ; lipid profiles ; resting blood pressure ; C-reactive protein ( measured with a high sensitive assay ) and fibrinogen levels ; blood glucose ; obesity ; physical activity levels ; subjective health status ( SF-36 ) ; Hospital Anxiety and Depression Scale . Results : Group comparison with independent t-tests showed a significantly greater improvement in the cardiovascular disease risk score for participants in the intervention group compared to st and ard care ( intervention 25.7 ± 22.8 to 23.15 ± 18.3 , control 25.03 ± 15.4 to 27.12 ± 16.1 , t = −1.81 , P < 0.05 ) . There were also significant improvements for the intervention group in activity levels ( intervention 9.41 ± 7.7 to 8.08 ± 5.7 , control 14.50 ± 5.5 to 9.83 ± 6.6 , t = −2.00 , P < 0.05 ) and the SF-36 domains of physical functioning ( intervention 70 ± 24.6 to 75.4 ± 11.1 , control 90.00 ± 12.4 to 83.16 ± 17.3 , t = −2.72 , P < 0.05 ) and mental health ( intervention 84 ± 40 to 92 ± 40 , control 88.00 ± 60 to 84 ± 44 , z = −2.06 , P < 0.05 ) . Conclusion : The results suggest that st and ard cardiac rehabilitation programmes are a feasible and effective means of reducing the risk of future cardiovascular events for patients after minor stroke and transient ischaemic attack Background Cardiac rehabilitation is very important for the recovery and the secondary prevention of cardiovascular disease , and one of its main strategies is to increase the level of physical activity . Internet and mobile phone based interventions have been successfully used to help people to achieve this . One of the components that are related to the efficacy of these interventions is tailoring of content to the individual . This trial is study ing the effect of a longitudinally tailored Internet and mobile phone based intervention that is based on models of health behaviour , on the level of physical activity and the adherence to the intervention , as an extension of a face-to-face cardiac rehabilitation stay . Methods / Design A parallel group , cluster r and omized controlled trial . The study population is adult participants of a cardiac rehabilitation programme in Norway with home Internet access and mobile phone , who in monthly clusters are r and omized to the control or the intervention condition . Participants have access to a website with information regarding cardiac rehabilitation , an online discussion forum and an online activity calendar . Those r and omized to the intervention condition , receive in addition tailored content based on models of health behaviour , through the website and mobile text messages . The objective is to assess the effect of the intervention on maintenance of self-management behaviours after the rehabilitation stay . Main outcome is the level of physical activity one month , three months and one year after the end of the cardiac rehabilitation programme . The r and omization of clusters is based on a true r and om number online service , and participants , investigators and outcome assessor are blinded to the condition of the clusters . Discussion The study suggests a theory-based intervention that combines models of health behaviour in an innovative way , in order to tailor the delivered content . The users have been actively involved in its design , and because of the use of Open- Source software , the intervention can easily and at low-cost be reproduced and exp and ed by others . Challenges are the recruitment in the elderly population and the possible underrepresentation of women in the study sample . Funding by Northern Norway Regional Health Authority . Trial registration Trial registry http://www . clinical trials.gov : NCT01223170 Background Methods to ensure sustained benefits of cardiac rehabilitation need to be explored . The aim was to assess the effect of a home-based intervention ( INT ) on exercise adherence and risk factors after cardiac rehabilitation . Design Prospect i ve r and omized study . Methods We evaluated patients who were followed for 1 year after either inpatient ( ICR ) or outpatient cardiac rehabilitation ( OCR ) by assessment of exercise capacity , physical activity , risk factors and quality of life  , both at the completion of rehabilitation , and after 1 year . Patients were r and omized to either be instructed how to use a diary of physical activities complemented by quarterly group meetings ( INT ) or to receive st and ard treatment ( usual care ) . Results Two hundred and sixty-one patients gave consent to be reevaluated after 1 year . Of these patients 33 were lost to follow-up ( two deaths ) ; thus 228 patients had complete 1-year follow-up data ( 195 male and 33 female , 91 % with coronary artery disease ) . At 1-year follow-up significantly more patients of the INT group than of the control group adhered to regular physical activity ( 73 vs. 40 % , P < 0.0001 ) . Moreover , INT patients showed a better evolution of body mass index and lipid values . In a stepwise multiple regression analysis the following variables showed a significant impact on regular physical activity at follow-up : study INT [ odds ratio ( OR ) : 4.19 , P < 0.0001 ] , previous cardiac surgery ( OR : 2.50 , P = 0.008 ) , BMI at baseline ( OR : 0.89 , P = 0.018 ) and quality of life at baseline ( OR : 1.58 , P = 0.041 ) . Conclusion Sustained benefits of cardiac rehabilitation can be documented 1 year after both inpatient and outpatient programmes . Self-monitoring of physical activity greatly increased long-term adherence to regular exercise , which in turn was associated with greater improvements of risk factors and quality of life Background : Psychological morbidity after an acute myocardial infa rct ion ( AMI ) is known to be common , but can be addressed by appropriate rehabilitation . The area in which this research was conducted experiences high rates of deprivation and of coronary heart disease and limited access to hospital-based rehabilitation . Responding to concern about psychological needs of AMI patients , a self-help package was introduced and evaluated alongside st and ard hospital-based cardiac rehabilitation . Aims : To evaluate the impact of a home-based self-help package ( the Heart Manual ) , alongside existing cardiac rehabilitation provision , on psychological morbidity and health status after AMI . A secondary aim was to assess the suitability of the Heart Manual for older patients aged over 80 years . Methods : A controlled observational study , comparing two cohorts of patients discharged from hospital after AMI . The intervention group was given the self-help package in addition to st and ard care . The control group received st and ard care alone . Outcome measures used were the Hospital Anxiety and Depression Scale and the EuroQol . Results : The intervention group showed significant improvement in anxiety and depression scores after 3 months and nonsignificant improvement in general health status .  Patients who attended hospital-based rehabilitation classes , and those aged over 80 years , also benefited from the intervention . Conclusion : A home-based self-help rehabilitation package is an effective tool alongside hospital-based rehabilitation classes and can be given to all age groups BACKGROUND Heart failure , a condition predominantly affecting the elderly , represents an ever-increasing clinical and financial burden for the NHS . Cardiac rehabilitation , a service that incorporates patient education , exercise training and lifestyle modification , requires further evaluation in heart failure management . AIM The aim of this study was to determine whether a cardiac rehabilitation programme improved on the outcomes of an outpatient heart failure clinic ( st and ard care ) for patients , over 60 years of age , with chronic heart failure . METHODS Two hundred patients ( 60 - 89 years , 66 % male ) with New York Heart Association ( NYHA ) II or III heart failure confirmed by echocardiography were r and omised . Both st and ard care and experimental groups attended clinic with a cardiologist and specialist nurse every 8 weeks . Interventions included exercise prescription , education , dietetics , occupational therapy and psychosocial counselling . The main outcome measures were functional status ( NYHA , 6-min walk ) , health-related quality of life ( MLHF and EuroQol ) and hospital admissions . RESULTS There were significant improvements in MLHF and EuroQol scores , NYHA classification and 6-min walking distance ( meters ) at 24 weeks between the groups ( p<0.001 ) . The experimental group had fewer admissions ( 11 vs. 33 , p<0.01 ) and spent fewer days in hospital ( 41 vs. 187 , p<0.001 ) . CONCLUSIONS Cardiac rehabilitation , already widely established in the UK , offers an effective model of care for older patients with heart failure There is substantial evidence of the importance of rehabilitation for patients recovering from acute myocardial infa rct ion in reducing mortality , morbidity , and psychological distress . The aim of this study was to compare a recently established home-based coronary rehabilitation programme in a coronary care unit ( CCU ) with the provision of a selection of information leaflets commonly provided for patients after their myocardial infa rct ion . A comparative study was carried out between two r and omly allocated groups of patients receiving either the Heart Manual rehabilitation programme ( n = 17 ) or general advice and information booklets ( n = 17 ) , with follow-up at 1 , 3 and 6 weeks after discharge for both groups . Question naire measurements included anxiety and depression ( HAD score ) , general practitioner ( GP ) visits , and patients ' perception of their confidence of recovery and progress . The findings show that patients receiving the Heart Manual had significantly higher scores in their confidence of recovery and perception of their progress than the group receiving booklets . The Heart Manual group showed improved levels of anxiety with unchanged scores in depression , while patients receiving the booklets experienced increased depression with little change in their anxiety levels . These results help to provide guidance for health care professionals on a form of rehabilitation which is effective for patients and their families in hospital and within the community OBJECTIVES To determine whether pulmonary rehabilitation carried out in a community setting is more effective than that carried out in a st and ard hospital setting and which is more cost-effective ; also whether telephone follow-up is both cost-effective and useful in prolonging the beneficial effects of a pulmonary rehabilitation programme . DESIGN A r and omised trial . Participants were r and omised in 2 x 2 factorial fashion to hospital or community rehabilitation and telephone or st and ard follow-up with review . SETTING Hospitals or community sites in Sheffield . The community venues were selected to be close to public transport routes and have good parking and level access . The two hospital venues were the physiotherapy gym and a staff gym within the grounds of the hospital . PARTICIPANTS Patients with chronic obstructive pulmonary disease diagnosed by respiratory physicians according to Global Initiative for Chronic Obstructive Lung Disease guidelines . INTERVENTIONS Participants were r and omised to one of four groups : hospital rehabilitation with no telephone follow-up ; hospital rehabilitation with telephone follow-up ; community rehabilitation with no telephone follow-up ; or community rehabilitation with telephone follow-up . All were blinded to the telephone intervention arm until 1 month post rehabilitation , when only the assessment team and research participants were unblinded . MAIN OUTCOME MEASURES The primary outcome measure was the difference in improvement in endurance shuttle walking test ( ESWT ) between hospital and community pulmonary rehabilitation groups post rehabilitation , and the difference in ESWT during 18 months ' follow-up between those receiving telephone encouragement and those receiving st and ard care . A secondary measure was health-related quality of life . RESULTS A total of 240 participants had evaluable data . Of these , 129 were r and omised to hospital rehabilitation ( 64 with telephone follow-up and 65 with no telephone follow-up ) and 111 to community rehabilitation ( 55 with telephone follow-up and 56 with no telephone follow-up ) . For the primary outcome measure , there were 162 patients with data for analysis : hospital rehabilitation with no telephone follow-up ( n = 38 ) ; hospital rehabilitation with telephone follow-up ( n = 48 ) ; community rehabilitation with no telephone follow-up ( n = 43 ) ; and community rehabilitation with telephone follow-up ( n = 33 ) . For the acute phase post-rehabilitation outcomes , before patients had the opportunity for telephone follow-up , we compared outcomes between the 76 patients in the community rehabilitation group and the 86 patients in the hospital rehabilitation group . Patients in the hospital rehabilitation group increased the distance they could walk at the post-rehabilitation follow-up by 283 m ( SD 360 m ) , an increase relative to baseline of 109 % ( SD 137 % ) . Patients in the community rehabilitation group increased the distance they could walk at the post-rehabilitation follow-up by 216 m ( SD 340 m ) , an increase relative to baseline of 91 % ( SD 133 % ) . There was no statistically significant difference between the groups [ 17.8 % ( 95 % CI -24.3 to 59.9 , p = 0.405 ) ] . For longer term outcomes at 6 , 12 and 18 months post rehabilitation there was no evidence of a rehabilitation group effect . After allowing for the initial post-rehabilitation baseline distance walked , time ( follow-up visit ) and the factorial design ( telephone follow-up group ) , the average difference in the post-rehabilitation follow-up distance walked on the ESWT between the hospital and community rehabilitation groups was 1.5 m ( 95 % CI -82.1 to 97.2 , p = 0.971 ) , and between the telephone and no-telephone groups it was 56.9 m ( 95 % CI -25.2 to 139 , p = 0.174 ) . There was no difference between hospital or community groups in terms of acute effect or persistence of effect . Health economic analysis favoured neither hospital nor community setting s , nor did it clearly favour telephone follow-up or routine care . CONCLUSIONS Pulmonary rehabilitation delivered in a community setting has similar efficacy to that produced in a more traditional hospital-based setting , both setting s producing significant improvements in terms of exercise capacity and quality of life acutely and after long-term follow-up . Health economic analysis showed that neither hospital nor community programmes were greatly favoured . The choice of model will depend on local factors of convenience , existing availability of re sources and incremental costs . Staff characteristics may be important in gaining optimal outcome , and care should be taken in staff recruitment and training . TRIAL REGISTRATION Current Controlled Trials IS RCT N86821773
Conclusions Compared to st and ard post-discharge care , regular telephone support interventions may help reduce feelings of anxiety and depression as well as , improve systolic blood pressure control and the likelihood of smoking cessation
Background Cardiac rehabilitation is offered to individuals after cardiac events to aid recovery and reduce the likelihood of further cardiac illness .
However , patient participation remains suboptimal and the provision of high quality care to an exp and ing population of patients with chronic heart conditions is becoming increasingly difficult .
A systematic review and meta- analysis was conducted to determine the effect of telephone support interventions compared with st and ard post-discharge care on coronary artery disease patient outcomes .