Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-Month results of a randomized clinical trial

• Published in: The American heart journal 2008-06, Vol.155 (6), p.1106-1113
• Main Authors: Zwisler, Ann-Dorthe Olsen, PhD, Soja, Anne Merete Boas, PhD, Rasmussen, Søren, PhD, Frederiksen, Marianne, MD, Abadini, Sadollah, MD, Appel, Jon, MD, Rasmussen, Hanne, PhD, Gluud, Christian, DMSc, Iversen, Lars, DMSc, Sigurd, Bjarne, MD, Madsen, Mette, MSc, Fischer-Hansen, Jørgen, DMSc
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cholesterol; Coronary heart disease; Drug therapy; Female; Heart; Heart attacks; Heart Failure - rehabilitation; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospitalization; Hospitals; Humans; Male; Medical sciences; Middle Aged; Mortality; Myocardial Ischemia - rehabilitation; Myocarditis. Cardiomyopathies; Risk Factors; Severity of Illness Index
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2007.12.033

Background Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic era of cardiology. Methods We conducted a centrally randomized single-center clinical trial with blinded assessment of the primary outcome: registry-based composite of total mortality, myocardial infarction, or acute first-time readmission due to heart disease. Other outcomes were hospitalization, risk profile, and quality of life. The trial included 770 participants (20-94 years) with congestive heart failure (12%), ischemic heart disease (58%), or high risk of ischemic heart disease (30%). Comprehensive cardiac rehabilitation is composed of 6 weeks of intensive intervention and systematic follow-up for 10.5 months. Results We randomized 380 patients to CCR versus 390 to UC. Randomization was well balanced. The primary outcome occurred in 31% of both groups (relative risk 0.96, 95% confidence interval 0.78-1.26). Compared with the UC group, CCR significantly reduced length of stay by 15% (95% confidence interval 1.1%-27.1%, P = .04), mean number of cardiac risk factors above target (4.5 vs 4.1, P = .01), patients with systolic blood pressure below target ( P = .003), physically inactivity ( P = .01), and unhealthy dietary habits ( P = .0003). Short-Form-36 and Hospital Anxiety and Depression Scale did not differ significantly. Conclusion At 12 months, the CCR and UC groups did not differ regarding the primary composite outcome. Comprehensive cardiac rehabilitation significantly reduced length of hospital stay and improved cardiac risk factors.