ABSTRACT
BACKGROUND: Hospital or centre-based cardiac rehabilitation (CR) can lengthen and improve life. However, most existing trials do not examine the effects of design characteristics. To examine the effects of these characteristics, this study compared an individualized cardiac rehabilitation programme to a standardized programme and examined what factors contributed most to programme effects. DESIGN: A prospective cohort analysis was done comparing patients using an individualized centre-based cardiac rehabilitation programme (ICR) in a mixed urban-rural region of the west of Scotland, to a standardized cardiac rehabilitation programme (SCR) provided at the same site three years previously. Both inter- and intra-programme differences in outcomes were explored. RESULTS: More patients were referred to ICR than SCR (749 versus 414 patients, p = 0.002) and the proportion of patients who subsequently attended was around 30% higher (p < 0.0001) although the overall rate of referral to ICR was lower (70% versus 62%, p = 0.002). ICR was associated with a reduction in hospital admission compared to SCR (HR: 0.664: 95% confidence interval (CI) 0.554 to 0.797). ICR patients also had significantly shorter hospitalizations (mean: 8.02 days versus 5.84 days, p < 0.05). ICR patients who attended at least 75% of the exercise sessions were significantly less likely to be hospitalized than individuals who partially attended (HR 2.39, 95% CI: 1.659 to 3.488) or did not participate in exercise sessions (HR 2.16, 95% CI: 1.482 to 3.143). CONCLUSIONS: Individualized content and supervised exercise components are key design characteristics for improving outcomes from centre-based CR in clinically representative populations.
Subject(s)
Exercise Therapy , Heart Diseases/rehabilitation , Secondary Prevention/methods , Aged , Analysis of Variance , Cardiology Service, Hospital , Chi-Square Distribution , Female , Heart Diseases/mortality , Home Care Services, Hospital-Based , Humans , Kaplan-Meier Estimate , Length of Stay , Male , Middle Aged , Patient Compliance , Patient Readmission , Program Evaluation , Proportional Hazards Models , Prospective Studies , Referral and Consultation , Scotland/epidemiology , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To understand the characteristics associated with participation in community-based exercise maintenance programs in patients with coronary heart disease (CHD) after completion of hospital-based cardiac rehabilitation in Scotland. METHODS: A mixed-methods approach was used (survey and focus groups) to explore determinants of participation in community-based exercise maintenance programs. RESULTS: Of 112 patients (67% male), 81 patients responded (73% response rate). Knowledge was high of the importance (19.2%) or high importance (75.6%) of physical activity to cardiac health. However, the focus groups identified that use of community-based exercise maintenance programs was affected by personal confidence, perceived meaningful support for people with CHD, and suitability of exercises to CHD patients. CONCLUSIONS: Decisions regarding the use of community-based exercise maintenance programs after hospital-based cardiac rehabilitation appear to be impacted by a range of factors linked to the views of exercise, confidence, and suitability of the program regimen to the individual with CHD.
