Abstract
Background
Participation in cardiac rehabilitation after acute myocardial infarction is sub-optimal.
Offering home-based rehabilitation may improve uptake. We report the first randomized
study of cardiac rehabilitation to include patient preference.
Aim
To compare the clinical effectiveness of a home-based rehabilitation with hospital-based
rehabilitation after myocardial infarction and to determine whether patient choice
affects clinical outcomes.
Design
Pragmatic randomized controlled trial with patient preference arms.
Setting
Rural South West England.
Methods
Patients admitted with uncomplicated myocardial infarction were offered hospital-based
rehabilitation classes over 8–10 weeks or a self-help package of six weeks' duration
(the Heart Manual) supported by a nurse. Primary outcomes at 9 months were mean depression and anxiety
scores on the Hospital Anxiety Depression scale, quality of life after myocardial
infarction (MacNew) score and serum total cholesterol.
Results
Of the 230 patients who agreed to participate, 104 (45%) consented to randomization
and 126 (55%) chose their rehabilitation programme. Nine month follow-up data were
available for 84/104 (81%) randomized and 100/126 (79%) preference patients. At follow-up
no difference was seen in the change in mean depression scores between the randomized
home and hospital-based groups (mean difference: 0; 95% confidence interval, −1.12 to 1.12) nor mean anxiety score (−0.07; −1.42 to 1.28), mean global MacNew score (0.14; −0.35 to 0.62) and mean total cholesterol levels (−0.18; −0.62 to 0.27). Neither were there any significant differences in outcomes between
the preference groups.
Conclusions
Home-based cardiac rehabilitation with the Heart Manual was as effective as hospital-based rehabilitation for patients after myocardial infarction.
Choosing a rehabilitation programme did not significantly affect clinical outcomes.
Keywords
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Article info
Publication history
Published online: December 30, 2006
Accepted:
November 2,
2006
Received in revised form:
October 6,
2006
Received:
July 25,
2006
Footnotes
☆Funding: NHS Executive South West (Research and Development) Project Grant D/02/10.99. The study's International Standard Randomized Control Trial Number is 52215857.
Identification
Copyright
© 2006 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
