Effectiveness of brief structured interventions on risk factor modification for patients with coronary heart disease: a systematic review A Behavior Change Intervention for Women in Cardiac Rehabilitation The Effects of Exercise in a Coronary Rehabilitation Programme Brief psychological intervention in phase I of cardiac rehabilitation after acute coronary syndrome. Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial. Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study) Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment Motivational counselling for physical activity in patients with coronary artery disease not participating in cardiac rehabilitation The effect of cardiac rehabilitation on quality of life in patients with acute coronary syndrome Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction. Cardiac rehabilitation after myocardial infarction. [Effects of a brief couples therapy intervention in coronary rehabilitation. A controlled study]. Rehabilitation outcomes following percutaneous coronary interventions (PCI). The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial [The effect of psychosocial rehabilitation after acute myocardial infarction. A randomized controlled trial].
Background The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established . Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low . Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors . Objectives The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease . Search strategy A literature search was performed using the following data bases MEDLINE ( 1966‐2006 ) , CINAHL ( 1982‐2006 ) , EMBASE ( 1980‐current ) and up to the Cochrane Controlled Trials Register ( Issue 2 , 2006 of Cochrane Library ) . In addition , the reference lists of relevant trials and conference proceedings were also scrutinised . Company representatives , experts and investigators were contacted to elicit further information . Selection criteria All r and omised and quasi‐r and omised controlled trials that compared the effects of brief structured interventions on risk factor modification in patients with coronary heart disease were considered for inclusion in the review . Data collection and analysis Eligibility of the trials for inclusion in the review , details of eligible trials and the method ological quality of the trials were assessed independently by two review ers . Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95 % confidence intervals . Where synthesis was inappropriate , trials were considered separately . Main results Seventeen trials involving a total of 4725 participants were included in the final review : three trials compared the effects of brief structured interventions  on diet modification ; seven on smoking cessation ; and seven on multiple risk factors . Two trials involving 76 patients compared brief structured intervention versus usual care for dietary modification . Although there was a tendency for more participants in the intervention arm to lose weight at the 12‐week follow up and achieve target cholesterol levels at the 6‐month follow up , these results were not statistically significant . Only one small trial involving 36 patients compared brief structured intervention and extensive intervention for dietary  modification and demonstrated a significant reduction in the percentage of energy obtained from fat and saturated fat intake among participants receiving extensive intervention . However , no difference in fish , fruit and vegetable intake between the groups was evident . Six trials involving 2020 patients compared brief structured intervention versus usual care for smoking cessation . There was no difference in the smoking cessation rates at the 3‐ and 6‐week follow up , however , there was evidence of a benefit of brief structured interventions  for smoking cessation at the 3‐ , 6‐ and 12‐month follow up . In the only trial that and compared brief structured intervention and extensive intervention for smoking cessation in 254 participants there was no clear difference of a likelihood of smoking cessation between the two groups . In the seven trials that compared brief structured intervention and usual care for multiple risk factor modification there was evidence of a benefit of the intervention on behavioural changes such as fat intake , weight loss and consequently on reduction in the body mass index , smoking cessation and physical activity among the participants . The findings concerning the effect on blood pressure , blood glucose levels and the lipid profile , however , remain inconclusive . Conclusions There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease . This review , however , supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease . Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors There is undeniable evidence for physical and psychosocial benefits of cardiac rehabilitation programs for individuals suffering from coronary heart disease . Yet , fewer women than men are referred to , begin , or complete cardiac rehabilitation programs . The numerous logistical , economic , and motivational barriers to healthy behavior change place women at risk for subsequent CHD events . To close this gender gap and improve outcomes , novel , efficacious , and individualized rehabilitative approaches for women with coronary heart disease are needed . The purpose of this article is to describe a theory-driven behavioral intervention design ed exclusively for women with coronary heart disease . The 12-week intervention is being tested in a r and omized controlled trial involving women referred to a cardiac rehabilitation program .  The tenets of the Transtheoretical Model of behavior change and motivational interviewing guided the development and implementation of the stage-matched , individualized intervention to promote healthy behavior change for women with coronary heart disease . The ongoing trial will examine the efficacy of the intervention on physiological and psychosocial outcomes Twenty-two male and female patients who had recently suffered a myocardial infa rct ion were r and omly assigned to a treatment group who participated in a 10-week exercise-based cardiac rehabilitation programme or a routine care group who did not participate in the rehabilitation programme .  Physiological and psychological function were assessed before the programme started and after it finished . Results indicated that the treatment group did not improve physiological functioning more than the control group but they did evidence statistically significant improved psychological functioning . This investigation appears to be the first attempt to assess the potential benefits of an exercise-based cardiac rehabilitation programme in Glasgow and supports the suggestion that exercise-based cardiac rehabilitation has psychological benefits INTRODUCTION Acute coronary syndrome ( ACS ) is an important cause of mortality and significant personal and financial costs . Cardiac rehabilitation ( CR ) programs have shown positive effects in reducing cardiovascular mortality and improving functional capacity . However , adherence is low and appears to be influenced by psychosocial factors , such as patients ' cognitions and emotional state . The objective was to evaluate the efficacy of a brief in-hospital psychological intervention to promote cognitive and emotional adaptation after ACS . METHODS One hundred and twenty-one patients with ACS , admitted to a coronary care unit in a central hospital , were r and omized to an experimental group ( EG , n=65 ) and a control group ( CG , n=56 ) . Portuguese versions of the HADS and BIPQ  were used to measure emotional well-being and illness cognitions . Two 1 h 15 min sessions were conducted 2 - 3 days after hospital admission , and a 20-minute follow-up session took place one month after discharge . Patients were assessed at four different time points : pre-test , post-test , and at 1- and 2-month follow-up . RESULTS The intervention had significant effects on anxiety , depression and illness cognitions . Anxiety and depression were significantly reduced and illness cognitions improved significantly in the EG compared to the control group . For the EG , these changes were maintained or enhanced at 1- and 2-month follow-up , whereas for the CG there was a deterioration in psychosocial adjustment . CONCLUSIONS These results indicate that a brief psychological intervention program delivered during hospitalization for ACS and combined with st and ard medical care can have positive effects in terms of psychosocial outcomes that have proven impact on cardiac rehabilitation and prognosis 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 Objectives 1 . To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases ( myocardial infa rct ion , acute coronary syndrome , percutaneous transluminal coronary angioplasty and coronary artery bypass grafting ) . 2 . To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group , in comparison with similar changes in the conventional care group . Design R and omized , controlled , parallel-group design ( intervention/conventional care ) . Setting Akershus County , southeast of Oslo City , Norway . Participants 500 patients , men and women , aged 40 - 85 years , who have sustained at least one of the above-mentioned cardiovascular diseases . Interventions 8 weeks of supervised , structured physical training of three periods of 20 min per week , targeting a heart rate of 60 - 70 % of the individual 's maximum ; home-based physical exercise training with the same basic schedule as in the supervised period ; quantification of patients ' compliance with the exercise programme by the use of wristwatches , information stored in the watch memory being retrieved once a month during the 3-year follow-up period ; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control Findings of systematic review s incorporating meta analysis are by nature hypothesis generating and should be carefully and judiciously interpreted . This need is epitomized by two of the largest review s of interventions to support risk factor reduction after a diagnosis of coronary heart disease ( Table 1 ) . These review s both included r and omized trials published in a similar timeframe ( up to 2003 or 2004 ) that compared the effects of various risk factor reduction programmes for patients with confirmed coronary heart disease to usual care . In 2004 , a Cochrane review found that supervised and unsupervised exercise-based cardiac rehabilitation provided to patients with different forms of coronary heart disease lowered all cause total mortality by 20 % and cardiac mortality by 26 % in 48 trials of 8940 patients . The review ers concluded that there was ‘ no difference in mortality effect between exercise-only cardiac rehabilitation and comprehensive cardiac rehabilitation , or by exercise dose or duration of followup ’ . Also , the exercise-based programmes did not reduce recurrent myocardial infa rct ion and the need for repeat coronary revascularization to statistically significant levels . Around the same time , a second review of 63 trials involving 21,295 patients who had undergone secondary cardiac prevention programmes found reductions of total mortality of 15 % and of acute myocardial infa rct ion of 17 % . However , in contrast to the previous review , the secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Also , benefits did not differ between programmes ‘ that incorporated education and counselling about coronary risk factors with a supervised exercise programme , those that included risk factor education or counselling but no exercise component , and those that consisted of only a structured exercise programme ’ . On first reading , these review s appear to offer different conclusions on effects on cardiovascular morbidity and regarding the benefits of supervised exercise . Either could be cited selectively to support or refute the benefits of exercise programmes for morbidity or to support or refute the incorporation of supervised exercise into services . Why might these different conclusions have come about and how should they be interpreted ? Firstly , it is unlikely that the different conclusions arise from differences in quality as both review s were of high quality as defined by PRISMA criteria and included many of the same trials : 37 of the 48 ( 77 % ) exercise-based trials were included in the 63 ( 59 % ) secondary prevention trials . Rather , issues of statistical power can explain the differences noted in morbidity . The forest plot analyses showed that , although exercise-based programmes in the Cochrane review did not reach statistically significant headline ‘ effect sizes ’ , there was a tendency towards reduced recurrent myocardial infa rct ion and the need for repeat coronary revascularization . The larger review of secondary prevention programmes considered over twice the number of events in the analysis of recurrent myocardial infa rct ion and found that secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Hence , focusing only on the presence or absence of AIM The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu , China . BACKGROUND Epidemiological studies indicate a dose- , level- and duration -dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality . Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes . DESIGN METHODS A r and omized controlled trial was conducted . Coronary heart disease patients ( n = 167 ) who met the sampling criteria in two tertiary medical centres in Chengdu , south-west China , were r and omly assigned to either an intervention group ( the cardiac rehabilitation programme ) or control group ( the routine care ) . The change of health behaviours ( walking performance , step II diet adherence , medication adherence , smoking cessation ) and physiological risk parameters ( serum lipids , blood pressure , body weight ) were assessed to evaluate the programme effect . RESULTS Patients in the intervention group demonstrated a significantly better performance in walking , step II diet adherence , medication adherence ; a significantly greater reduction in serum lipids including triglyceride , total cholesterol , low-density lipoprotein ; and significantly better control of systolic and diastolic blood pressure at three months . The majority of these positive impacts were maintained at six months . The effect of the programme on smoking cessation , body weight , serum high-density lipoprotein , was not confirmed . CONCLUSIONS A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients . Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease . RELEVANCE TO CLINICAL PRACTICE This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients . Furthermore , the hospital-home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care 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 : Many patients with coronary artery disease ( CAD ) fail to attend cardiac rehabilitation following acute coronary events because they lack motivation to exercise . Theory-based approaches to promote physical activity among non- participants in cardiac rehabilitation are required . Design : A r and omized trial comparing physical activity levels at baseline , 6 , and 12 months between a motivational counselling ( MC ) intervention group and a usual care ( UC ) control group . Method : One hundred and forty-one participants hospitalized with acute coronary syndromes not planning to attend cardiac rehabilitation were recruited at a single centre and r and omized to either MC ( n = 69 ) or UC ( n = 72 ) . The MC intervention , design ed from an ecological perspective , included one face-to-face contact and eight telephone contacts with a trained physiotherapist over a 52-week period . The UC group received written information about starting a walking programme and brief physical activity advice from their attending cardiologist .  Physical activity was measured by : 7-day physical activity recall interview ; self-report question naire ; and pedometer at baseline , 6 , and 12 months after r and omization . Results : Latent growth curve analyses , which combined all three outcome measures into a single latent construct , showed that physical activity increased more over time in the MC versus the UC group ( µadd = 0.69 , p < 0.05 ) . Conclusion : Patients with CAD not participating in cardiac rehabilitation receiving a theory-based motivational counselling intervention were more physically active at follow-up than those receiving usual care . This intervention may extend the reach of cardiac rehabilitation by increasing physical activity in those disinclined to participate in structured programmes Background : Acute coronary syndrome is one of the major cardiovascular diseases that leads to a significant amount of morbidity . The purpose of the present study was to investigate the effect of cardiac rehabilitation on quality of life in patients with acute coronary syndrome . Material s and Methods : This was a clinical trial study conducted on 50 patients with acute coronary syndrome admitted to the coronary care units of Shohada Hospital in Isfahan in 2013 - 2014 . The participants were r and omly assigned to control ( n = 25 ) and study ( n = 25 ) groups . The study group received cardiac rehabilitation in phase 1 and 2 . Phase 1 was conducted in a hospital in Isfahan province that had no cardiac rehabilitation center but had minimal cardiac rehabilitation equipments . Phase 2 was conducted at home by follow-up through telephone and referring the patients to the hospital . The control group received usual cardiac rehabilitation . The data were collected via a demographic question naire and SF-36 quality of life question nre before and 1 month after intervention by the research er . Data were analyzed by independent sample s t-test . Results : In the study group , the mean scores in all domains of quality of life increased significantly after intervention ( P < 0.05 ) . In the control group , the mean scores of quality of life were not significantly different before and after intervention ( P > 0.05 ) . A significant difference was found between the study and control groups in all domains of quality of life except for general health and social function ( P < 0.05 ) in favor of the study group . Conclusions : The results of this study showed that cardiac rehabilitation program could lead to improving the quality of life in the patients with acute coronary syndrome We have design ed a new 4-week hospitalized phase II cardiac rehabilitation program . The purpose of the present study is to clarify whether the physical and psychological status of patients with myocardial infa rct ion ( MI ) improves after participation in our program . Twenty-nine patients ( 27 males , two females ) with acute MI who enrolled in the 4-week hospitalized phase II rehabilitation program were assessed . All patients enrolled in this study had received coronary interventions . The rehabilitation consisted of exercise training , education and counseling . We evaluated the physical and psychological status of the patients before and just after the program , and at a 6-month follow up . The physical status was assessed by exercise tolerance measured by the peak oxygen consumption and anaerobic threshold , frequency of exercise , and serum concentrations of triglyceride , total cholesterol , high-density lipoprotein-cholesterol , and low-density lipoprotein-cholesterol . The psychological status was assessed by the Spielberger state-trait anxiety inventory question naire ( STAI ) and the self-rating question naire for depression ( SRQ-D ) .  Thirty-four patients ( 27 men , seven women ) with MI who did not participate in our rehabilitation program  served as a control group . After participation in our rehabilitation program , exercise tolerance and the serum lipid profiles of the patients were improved compared with those before rehabilitation . These parameters had improved significantly 6 months after rehabilitation . The STAI anxiety score was improved significantly and the SRQ-D depression score tended to be improved just after the rehabilitation program . Regular physical activity was continued even 6 months after the completion of the program . Our hospitalized phase II cardiac rehabilitation program improved the management of cardiac risk factors and the psychological status in patients with MI . This comprehensive program may contribute to the secondary prevention of MI as well as the recovery of physical and psychological activities 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 The effects of a brief couple therapy intervention in cardiac rehabilitation was investigated in a r and omised controlled trial . The treating physician and a psychologist conducted an intervention of two to four sessions with 19 patients with coronary diseases at the IIa stage according to WHO and their partners . The 21 patients in the control group received st and ard care with no additional intervention .  Depressive symptoms , global self-rating of health status and disease related concerns were assessed at the beginning of training and nine months later . Patients in the experimental group more often stated to feel better immediately after the intervention . Over the observation period they showed significantly more favour-able changes in observer rated depressive symptoms , self-rated health status and concerns . Patients and partners in the experimental group assessed the outcome of rehabilitation significantly more positive after nine months . The findings suggest that a very short couple therapy intervention , which can be administered in routine care , can have positive effects in cardiac out-patient rehabilitation . Larger studies are required for testing whether the effects of such interventions are restricted to depressive symptoms and subjective appraisal s , or whether other outcome criteria such as mortality can also be influenced This prospect i ve study evaluated the effect of an individualized , comprehensive , home-based cardiac rehabilitation program combining exercise training with risk factor modification and psychosocial counseling on risk factors , psychological well-being , functional capacity , and work resumption in 99 post-percutaneous coronary interventions ( PCI ) patients r and omized to control ( st and ard care plus telephone follow-up  , n=49 ) or intervention ( individualized , comprehensive , home-based cardiac rehabilitation , n=50 ) groups . Data were collected at time 1 ( T(1 ) ) during hospital admission , time 2 ( T(2 ) ) approximately 2 months post-PCI , and time 3 ( T(3 ) ) approximately 12 months post-PCI . Results suggest that the allocation to an individualized , comprehensive , home-based cardiac rehabilitation program provided more advantageous outcomes . At both follow-ups , the intervention group showed within-group improvement in serum cholesterol levels ( P<0.02 ; P<0.01 ) and exercise participation ( P<0.001 ; P<0.001 ) with differences in exercise participation favoring the intervention group ( P<0.01 ) at T(2 ) . Repeated measures ANOVA showed significant improvements over time in body mass index ( BMI ) ( P<0.01 ) , psychological well-being ( P<0.001 ) , and functional capacity ( P<0.001 ) for both groups . More patients in the intervention group had returned to work at T(2 ) ( P<0.001 ) and did so more quickly ( P<0.01 ) . These findings suggest that an individualized , comprehensive , home-based cardiac rehabilitation program improves risk factor profiles and work resumption patterns for patients following PCI 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 : INTRODUCTION The aim of the study was to examine the effect of group based psychosocial rehabilitation following discharge compared to usual care . MATERIAL AND METHODS A r and omised clinical trial was performed in the setting of a coronary unit at Herlev University Hospital . The study sample included 200 patients admitted to the unit with a diagnosis of acute myocardial infa rct ion . All patients received usual care .  Besides , the intervention group was offered two group based outpatient counselling sessions with focus on reduction of risk factors and psychosocial adjustment after myocardial infa rct ion . Coping strategies , anxiety and depression , general health , physical function and number of readmissions were measured on the basis of the question naires HAD and mini-MAC . Participants completed question naires before discharge and again six weeks and four months after discharge . RESULTS The intervention did not significantly affect coping strategies , general health or physical function . The readmission rate was significantly lower in the intervention group compared to the control group . The mortality rate in the intervention group was lower after four months , one year and four years . DISCUSSION Possible explanations for the lack of effect in psychosocial parameters are the complex target group with no restrictions in gender and age and no intervention targeted the relatives . The lower mortality rate in the intervention group might be due to the intervention . However , it could also be due to variables not available in this study , such as the type of infa rct ion and changes in lifestyle
There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease .
This review , however , supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease .
Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors
BACKGROUND The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established .
Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low .
Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors .
OBJECTIVES The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease .