A controlled intervention to increase participation in cardiac rehabilitation.

BACKGROUND: Cardiac rehabilitation programs are greatly underutilized. DESIGN: This study was a multicenter interventional controlled cohort study. METHODS: From cardiothoracic departments of five medical centers, 520 coronary artery bypass graft (CABG) patients (386 men) were enrolled in the control arm and 504 CABG patients (394 men) in the intervention arm of our study. A 1-hour seminar to medical staff on the benefits of cardiac rehabilitation followed the control phase and preceded the intervention phase. Patients in the intervention arm received written and oral explanations on cardiac rehabilitation benefits and eligibility, and a follow-up telephone call 2 weeks after hospital discharge. Patients in both study arms were interviewed in the hospital prior to CABG surgery and in their homes a year later. RESULTS: Rates of participation in cardiac rehabilitation were 16.5% (86/520) for the control arm and 31.0% (156/504) for the intervention arm (p < 0.001). Factors strongly associated with participation in cardiac rehabilitation were: belonging to the intervention arm (OR: 2.06 95% CI: 1.46-2.90, p < 0.0001), male sex, average or above average income, sports related physical activity before surgery, younger age and BMI > 30 kg/m(2). Particularly high increases in participation rates following the implementation were observed among subpopulations of 10 years or less education and those reporting below average income. "Lack of knowledge" regarding cardiac rehabilitation was the reason most commonly stated for not participating in a cardiac rehabilitation program. CONCLUSION: Participation in cardiac rehabilitation almost doubled following a low cost intervention with significant effects on subpopulations that have been underrepresented in cardiac rehabilitation programs.

[Health-related quality of life of Israeli heart patients according to the MacNew heart disease specific instrument].

BACKGROUND: Assessment of health-related quality of life (HRQL) using generic measures may not be optimally responsive to treatment interventions. The disease-specific instrument, MacNew heart disease HRQL questionnaire (MacNew), is designed specifically to evaluate HRQL among heart patients. AIMS: To validate the Hebrew version of MacNew, and to report HRQL of Israeli chronic cardiac patients. METHODS: The generic SF-36 and the MacNew HRQL questionnaires were administered to 221 Hebrew speaking heart patients treated in the outpatient clinic of the Sheba Medical Center. RESULTS: According to the SF-36, HRQL is relatively low in the cardiac patients compared to Israeli norms, and comparable to norms of American heart patients according to the MacNew. Heart-failure patients have the lowest HRQL scores in all three dimensions (physical, mental, social) and the total score identified for the MacNew. Confirmatory factor analysis verified good model fit for physical/emotional domain items, supporting structural validity. Spearman coefficients correlating MacNew with parallel SF-36 domains were moderate-high (r=0.63-0.89, p<0.01), supported convergent validity. Cronbach's alpha was > 0.9 (total MacNew score, dimensions), supporting internal reliability, as was the test-retest reliability, examined 1.5 months later among 11 patients. The different scales discriminated between heart failure, angina pectoris, and other heart patients, supporting criterion validity. A multilinear regression model showed significant correlation between heart failure, past myocardial infarction (MI), years of schooling, duration of heart disease and HRQL. CONCLUSIONS: Among patients with heart disease, the MacNew is highly acceptable and maintains good psychometric properties, comparing favorably with SF-36. DISCUSSION AND CONCLUSION: These findings suggest MacNew's utility for measuring disease-specific HRQL in Israeli heart patients.

The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial.

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 designed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery. METHODS/DESIGN: A controlled prospective 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 designed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00356863.