[Heart rehabilitation. Cost-effectiveness analysis]. / Rehabilitación cardíaca. Análisis de coste-efectividad.

OBJECTIVE: Heart rehabilitation programmes improve the quality of life of coronary patients and the prognosis of the illness. Implementing these therapeutic systems into practice would be easier if their economic efficiency was proven. MATERIAL AND METHODS: The expenses created by 180 survivors of a myocardial infarction have been studied at the first and sixth year after the acute episode. The survivors were divided, at random, into two groups of 90. One of them (RG) underwent a rehabilitation programme (physical training, psychological action and control guidelines of risk factors). The other (CG) served as a control. RESULTS: The profits, analyzing the direct expenses (readmissions to hospital) were of 5,074,039 ptas. the first year (CG: 19,901,578; RG: 14,827,539), and of 17,451,910 ptas. at the end of the study (CG: 54,370,249; RG: 36,918,339). Better results were obtained when reviewing the indirect expenses (derived from return to work), since the profits were of 26,000,000 ptas. after the first year (CG: 54,750,000; RG: 28,750,000) and of 209,750,000 at the sixth year (CG: 438,000,000; RG: 228,250,000). The saving per patient was of 272,437 ptas. during the first 12 months and of 2,415,220 at the end of the follow-up. CONCLUSIONS: These results justify the fact that the Public Administration and private Insurance Providers are taking into account the adequacy of implementing these therapeutic systems into practice.

[The control of risk factors in cardiac rehabilitation programs]. / Control de factores de riesgo en los programas de rehabilitación cardíaca.

Patients with ischaemic heart disease are at high risk of developing new clinical cardiac events and cardiac death in the following years. Appropriate Secondary Prevention Programs have proved to be useful both to slow the progression of coronary disease and to decrease the probability of new clinical events and the overall mortality. Cardiac rehabilitation programs constitute the best current approach directed to the modification of risk factors. The programs have not only significantly improved the risk profile of ischaemic patients but also have contributed to the acceptance of new healthy life style.

[Rehabilitation in ischemic cardiopathy. Results at the level of quality of life and prognosis]. / Rehabilitación en la cardiopatía isquémica. Resultados a nivel de calidad de vida y sobre el pronóstico.

Cardiac rehabilitation programs, by means of physical, psychosocial and risk control factors, intend to improve the life style and prognosis of coronary patients. In this study, we analyzed the results obtained from 349 patients, 310 with acute myocardial infarction and 39 after coronary artery surgery. The average follow up period was 36 months and the average age was 53.9 years. The results showed that 84.3% stopped smoking, 60% returned to work after a heart attack and 51.36% after coronary artery bypass. Functional capacity improved significantly with p < 0.001. Although 50% of the patients considered themselves sexually incapacitated, the number of coitus per month is similar to that of healthy people of the same age. There were 12 new infarctions (1.28 por 100 patients per year), and 11 cardiac-related deaths (1.18 per 100 patients per year). All the deaths occurred in the group of patients with myocardial infarction, and with a significant increase in the elevation of the ST in the necrosis area, during an exercise testing, indicating extensive areas of dyskinesis. Based on these results, we have reached the conclusion that steps must be taken to reduce the high percentage of patients who leave the program. In our study this was significantly low at 21.5%.