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Rod S Taylor - One of the best experts on this subject based on the ideXlab platform.
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home based versus centre based Cardiac Rehabilitation
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lindsey Anderson, Georgina A Sharp, Rebecca J Norton, Hasnain M Dalal, Sarah Dean, Kate Jolly, Aynsley Cowie, Anna Zawada, Rod S TaylorAbstract:Background Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based Cardiac Rehabilitation programmes are offered to individuals after Cardiac events to aid recovery and prevent further Cardiac illness. Home-based Cardiac Rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review originally published in 2009. Objectives To compare the effect of home-based and supervised centre-based Cardiac Rehabilitation on mortality and morbidity, health-related quality of life, and modifiable Cardiac risk factors in patients with heart disease. Search methods To update searches from the previous Cochrane review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 9, 2014), MEDLINE (Ovid, 1946 to October week 1 2014), EMBASE (Ovid, 1980 to 2014 week 41), PsycINFO (Ovid, 1806 to October week 2 2014), and CINAHL (EBSCO, to October 2014). We checked reference lists of included trials and recent systematic reviews. No language restrictions were applied. Selection criteria Randomised controlled trials (RCTs) that compared centre-based Cardiac Rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction (MI), angina, heart failure or who had undergone revascularisation. Data collection and analysis Two authors independently assessed the eligibility of the identified trials and data were extracted by a single author and checked by a second. Authors were contacted where possible to obtain missing information. Main results Seventeen trials included a total of 2172 participants undergoing Cardiac Rehabilitation following an acute MI or revascularisation, or with heart failure. This update included an additional five trials on 345 patients with heart failure. Authors of a number of included trials failed to give sufficient detail to assess their potential risk of bias, and details of generation and concealment of random allocation sequence were particularly poorly reported. In the main, no difference was seen between home- and centre-based Cardiac Rehabilitation in outcomes up to 12 months of follow up: mortality (relative risk (RR) = 0.79, 95% confidence interval (CI) 0.43 to 1.47, P = 0.46, fixed-effect), Cardiac events (data not poolable), exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.29 to 0.08, P = 0.29, random-effects), modifiable risk factors (total cholesterol: mean difference (MD) = 0.07 mmol/L, 95% CI -0.24 to 0.11, P = 0.47, random-effects; low density lipoprotein cholesterol: MD = -0.06 mmol/L, 95% CI -0.27 to 0.15, P = 0.55, random-effects; systolic blood pressure: mean difference (MD) = 0.19 mmHg, 95% CI -3.37 to 3.75, P = 0.92, random-effects; proportion of smokers at follow up (RR = 0.98, 95% CI 0.79 to 1.21, P = 0.83, fixed-effect), or health-related quality of life (not poolable). Small outcome differences in favour of centre-based participants were seen in high density lipoprotein cholesterol (MD = -0.07 mmol/L, 95% CI -0.11 to -0.03, P = 0.001, fixed-effect), and triglycerides (MD = -0.18 mmol/L, 95% CI -0.34 to -0.02, P = 0.03, fixed-effect, diastolic blood pressure (MD = -1.86 mmHg; 95% CI -0.76 to -2.95, P = 0.0009, fixed-effect). In contrast, in home-based participants, there was evidence of a marginally higher levels of programme completion (RR = 1.04, 95% CI 1.01 to 1.07, P = 0.009, fixed-effect) and adherence to the programme (not poolable). No consistent difference was seen in healthcare costs between the two forms of Cardiac Rehabilitation. Authors' conclusions This updated review supports the conclusions of the previous version of this review that home- and centre-based forms of Cardiac Rehabilitation seem to be equally effective for improving the clinical and health-related quality of life outcomes in low risk patients after MI or revascularisation, or with heart failure. This finding, together with the absence of evidence of important differences in healthcare costs between the two approaches, supports the continued expansion of evidence-based, home-based Cardiac Rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme should reflect the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based Cardiac Rehabilitation reported in these short-term trials can be confirmed in the longer term. A number of studies failed to give sufficient detail to assess their risk of bias.
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exercise based Cardiac Rehabilitation in heart transplant recipients
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lindsey Anderson, Tricia T Nguyen, Christian Have Dall, Laura Burgess, Charlene Bridges, Rod S TaylorAbstract:BACKGROUND:Heart transplantation is considered to be the gold standard treatment for selected patients with end-stage heart disease when medical therapy has been unable to halt progression of the underlying pathology. Evidence suggests that aerobic exercise training may be effective in reversing the pathophysiological consequences associated with Cardiac denervation and prevent immunosuppression-induced adverse effects in heart transplant recipients. OBJECTIVES:To determine the effectiveness and safety of exercise-based Rehabilitation on the mortality, hospital admissions, adverse events, exercise capacity, health-related quality of life, return to work and costs for people after heart transplantation. SEARCH METHODS:We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO) and Web of Science Core Collection (Thomson Reuters) to June 2016. We also searched two clinical trials registers and handsearched the reference lists of included studies. SELECTION CRITERIA:We included randomised controlled trials (RCTs) of parallel group, cross-over or cluster design, which compared exercise-based interventions with (i) no exercise control (ii) a different dose of exercise training (e.g. low- versus high-intensity exercise training); or (iii) an active intervention (i.e. education, psychological intervention). The study population comprised adults aged 18 years or over who had received a heart transplant. DATA COLLECTION AND ANALYSIS:Two review authors independently screened all identified references for inclusion based on pre-specified inclusion criteria. Disagreements were resolved by consensus or by involving a third person. Two review authors extracted outcome data from the included trials and assessed their risk of bias. One review author extracted study characteristics from included studies and a second author checked them against the trial report for accuracy. MAIN RESULTS:We included 10 RCTs that involved a total of 300 participants whose mean age was 54.4 years. Women accounted for fewer than 25% of all study participants. Nine trials which randomised 284 participants to receive exercise-based Rehabilitation (151 participants) or no exercise (133 participants) were included in the main analysis. One cross-over RCT compared high-intensity interval training with continued moderate-intensity training in 16 participants. We reported findings for all trials at their longest follow-up (median 12 weeks).Exercise-based Cardiac Rehabilitation increased exercise capacity (VO2peak) compared with no exercise control (MD 2.49 mL/kg/min, 95% CI 1.63 to 3.36; N = 284; studies = 9; moderate quality evidence). There was evidence from one trial that high-intensity interval exercise training was more effective in improving exercise capacity than continuous moderate-intensity exercise (MD 2.30 mL/kg/min, 95% CI 0.59 to 4.01; N = 16; 1 study). Four studies reported health-related quality of life (HRQoL) measured using SF-36, Profile of Quality of Life in the Chronically Ill (PLC) and the World Health Organization Quality Of Life (WHOQoL) - BREF. Due to the variation in HRQoL outcomes and methods of reporting we were unable to meta-analyse results across studies, but there was no evidence of a difference between exercise-based Cardiac Rehabilitation and control in 18 of 21 HRQoL domains reported, or between high and moderate intensity exercise in any of the 10 HRQoL domains reported. One adverse event was reported by one study.Exercise-based Cardiac Rehabilitation improves exercise capacity, but exercise was found to have no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients whose health is stable.There was no evidence of statistical heterogeneity across trials for exercise capacity and no evidence of small study bias. The overall risk of bias in included studies was judged as low or unclear; more than 50% of included studies were assessed at unclear risk of bias with respect to allocation concealment, blinding of outcome assessors and declaration of conflicts of interest. Evidence quality was assessed as moderate according to GRADE criteria. AUTHORS' CONCLUSIONS:We found moderate quality evidence suggesting that exercise-based Cardiac Rehabilitation improves exercise capacity, and that exercise has no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients. Cardiac Rehabilitation appears to be safe in this population, but long-term follow-up data are incomplete and further good quality and adequately-powered trials are needed to demonstrate the longer-term benefits of exercise on safety and impact on both clinical and patient-related outcomes, such as health-related quality of life, and healthcare costs.
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Cardiac Rehabilitation for people with heart disease an overview of cochrane systematic reviews
Cochrane Database of Systematic Reviews, 2014Co-Authors: Lindsey Anderson, Rod S TaylorAbstract:Background Overviews are a new approach to summarising evidence and synthesising results from related systematic reviews. Objectives To conduct an overview of Cochrane systematic reviews to provide a contemporary review of the evidence for delivery of Cardiac Rehabilitation, to identify opportunities for merging or splitting existing Cochrane reviews, and to identify current evidence gaps to inform new Cardiac Rehabilitation systematic review titles. Methods We searched The Cochrane Database of Systematic Reviews (2014, Issue 10) to identify systematic reviews that addressed the objectives of this overview. We assessed the quality of included reviews using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) measurement tool and the quality of the evidence for reported outcomes using the GRADE framework. The focus of the data presentation was descriptive with detailed tabular presentations of review level and trial level characteristics and results. Main results We found six Cochrane systematic reviews and judged them to be of high methodological quality. They included 148 randomised controlled trials (RCTs) in 98,093 participants. Compared with usual care alone, the addition of exercise-based Cardiac Rehabilitation in low-risk people after myocardial infarction or percutaneous coronary intervention or with heart failure appeared to have no impact on mortality, but did reduce hospital admissions and improved health-related quality of life. Psychological- and education-based interventions alone appeared to have little or no impact on mortality or morbidity but may have improved health-related quality of life. Home- and centre-based programmes were equally effective in improving quality of life outcomes at similar healthcare costs. Selected interventions can increase the uptake of Cardiac Rehabilitation programmes whilst there is currently only weak evidence to support interventions that improve adherence to Cardiac Rehabilitation programmes. The quality of the primary RCTs in the included systematic reviews was variable, and limitations in the methodological quality of the RCTs led to downgrading of the quality of the evidence, which varied widely by review and by outcome. Authors' conclusions Exercise-based Cardiac Rehabilitation is an effective and safe therapy to be used in the management of clinically stable people following myocardial infarction or percutaneous coronary intervention or who have heart failure. Future RCTs of Cardiac Rehabilitation need to improve their reporting methods and reflect the real world practice better including the recruitment of higher risk people and consideration of contemporary models of Cardiac Rehabilitation delivery, and identify effective interventions for enhancing adherence to Rehabilitation.
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home based Cardiac Rehabilitation versus hospital based Rehabilitation a cost effectiveness analysis
International Journal of Cardiology, 2007Co-Authors: Rod S Taylor, David R. Thompson, Hasnain M Dalal, A Watt, Philip Evans, John L Campbell, K L Q Read, A J Mourant, Jenny Wingham, D Pereira J GrayAbstract:Abstract Background Home-based Cardiac Rehabilitation offers an alternative to traditional, hospital-based Cardiac Rehabilitation. Aim To compare the cost effectiveness of home-based Cardiac Rehabilitation and hospital-based Cardiac Rehabilitation. Methods 104 patients with an uncomplicated acute myocardial infarction and without major comorbidity were randomized to receive home-based Rehabilitation ( n =60) i.e. nurse facilitated, self-help package of 6 weeks' duration (the Heart Manual) or hospital-based Rehabilitation for 8–10 weeks ( n =44). Complete economic data were available in 80 patients (48 who received home-based Rehabilitation and 32 who received hospital-based Rehabilitation). Healthcare costs, patient costs, and quality of life (EQ-5D4.13) were assessed over the 9 months of the study. Results The cost of running the home-based Rehabilitation programme was slightly lower than that of the hospital-based programme (mean (95% confidence interval) difference −£30 (−£45 to −£12) [−€44, −€67 to −€18] per patient. The cost difference was largely the result of reduced personnel costs. Over the 9 months of the study, no significant difference was seen between the two groups in overall healthcare costs (£78, −£1102 to £1191 [−€115, −€1631 to −€1763] per patient) or quality adjusted life-years (−0.06 (−0.15 to 0.02)). The lack of significant difference between home-based Rehabilitation and hospital-based Rehabilitation did not alter when different costs and different methods of analysis were used. Conclusions The health gain and total healthcare costs of the present hospital-based and home-based Cardiac Rehabilitation programmes for patients after myocardial infarction appear to be similar. These initial results require affirmation by further economic evaluations of Cardiac Rehabilitation in different settings.
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home based Cardiac Rehabilitation compared with centre based Rehabilitation and usual care a systematic review and meta analysis
International Journal of Cardiology, 2006Co-Authors: Kate Jolly, Rod S Taylor, Gregory Y H Lip, Andrew StevensAbstract:Abstract Background To determine the effectiveness of home-based Cardiac Rehabilitation programmes compared with (i) usual care and (ii) supervised centre-based Cardiac Rehabilitation on mortality, health related quality of life and modifiable Cardiac risk factors of patients with coronary heart disease. Methods Systematic review and meta-analysis of randomised controlled trials. Main outcome measures: mortality, smoking cessation, exercise capacity, systolic blood pressure, total cholesterol, psychological status, and health related quality of life. Results Eighteen included trials for home versus usual Rehabilitation and six trials of home versus supervised centre-based Rehabilitation were identified. The home-based interventions were clinically heterogeneous, trials often small, with quality poorly reported. Compared with usual care, home-based Cardiac Rehabilitation had a 4 mm Hg (95% CI 6.5, 1.5) greater reduction in systolic blood pressure, and a reduced relative risk of being a smoker at follow-up (RR 0.71, 95% CI 0.51, 1.00). Differences in exercise capacity, total cholesterol, anxiety and depression were all in favour of the home-based group. In patients post-myocardial infarction exercise capacity was significantly improved in the home Rehabilitation group by 1.1 METS (95% CI 0.2, 2.1) compared to usual care. The comparison of home-based with supervised centre-based Cardiac Rehabilitation revealed no significant differences in exercise capacity, systolic blood pressure and total cholesterol. Conclusions Current evidence does not show home-based Cardiac Rehabilitation to be significantly inferior to centre-based Rehabilitation for low-risk Cardiac patients. However, the numbers of patients included are less than 750 and ongoing trials will contribute to the debate on the acceptability, effectiveness and cost-effectiveness of home-based Cardiac Rehabilitation.
Lindsey Anderson - One of the best experts on this subject based on the ideXlab platform.
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home based versus centre based Cardiac Rehabilitation
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lindsey Anderson, Georgina A Sharp, Rebecca J Norton, Hasnain M Dalal, Sarah Dean, Kate Jolly, Aynsley Cowie, Anna Zawada, Rod S TaylorAbstract:Background Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based Cardiac Rehabilitation programmes are offered to individuals after Cardiac events to aid recovery and prevent further Cardiac illness. Home-based Cardiac Rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review originally published in 2009. Objectives To compare the effect of home-based and supervised centre-based Cardiac Rehabilitation on mortality and morbidity, health-related quality of life, and modifiable Cardiac risk factors in patients with heart disease. Search methods To update searches from the previous Cochrane review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 9, 2014), MEDLINE (Ovid, 1946 to October week 1 2014), EMBASE (Ovid, 1980 to 2014 week 41), PsycINFO (Ovid, 1806 to October week 2 2014), and CINAHL (EBSCO, to October 2014). We checked reference lists of included trials and recent systematic reviews. No language restrictions were applied. Selection criteria Randomised controlled trials (RCTs) that compared centre-based Cardiac Rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction (MI), angina, heart failure or who had undergone revascularisation. Data collection and analysis Two authors independently assessed the eligibility of the identified trials and data were extracted by a single author and checked by a second. Authors were contacted where possible to obtain missing information. Main results Seventeen trials included a total of 2172 participants undergoing Cardiac Rehabilitation following an acute MI or revascularisation, or with heart failure. This update included an additional five trials on 345 patients with heart failure. Authors of a number of included trials failed to give sufficient detail to assess their potential risk of bias, and details of generation and concealment of random allocation sequence were particularly poorly reported. In the main, no difference was seen between home- and centre-based Cardiac Rehabilitation in outcomes up to 12 months of follow up: mortality (relative risk (RR) = 0.79, 95% confidence interval (CI) 0.43 to 1.47, P = 0.46, fixed-effect), Cardiac events (data not poolable), exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.29 to 0.08, P = 0.29, random-effects), modifiable risk factors (total cholesterol: mean difference (MD) = 0.07 mmol/L, 95% CI -0.24 to 0.11, P = 0.47, random-effects; low density lipoprotein cholesterol: MD = -0.06 mmol/L, 95% CI -0.27 to 0.15, P = 0.55, random-effects; systolic blood pressure: mean difference (MD) = 0.19 mmHg, 95% CI -3.37 to 3.75, P = 0.92, random-effects; proportion of smokers at follow up (RR = 0.98, 95% CI 0.79 to 1.21, P = 0.83, fixed-effect), or health-related quality of life (not poolable). Small outcome differences in favour of centre-based participants were seen in high density lipoprotein cholesterol (MD = -0.07 mmol/L, 95% CI -0.11 to -0.03, P = 0.001, fixed-effect), and triglycerides (MD = -0.18 mmol/L, 95% CI -0.34 to -0.02, P = 0.03, fixed-effect, diastolic blood pressure (MD = -1.86 mmHg; 95% CI -0.76 to -2.95, P = 0.0009, fixed-effect). In contrast, in home-based participants, there was evidence of a marginally higher levels of programme completion (RR = 1.04, 95% CI 1.01 to 1.07, P = 0.009, fixed-effect) and adherence to the programme (not poolable). No consistent difference was seen in healthcare costs between the two forms of Cardiac Rehabilitation. Authors' conclusions This updated review supports the conclusions of the previous version of this review that home- and centre-based forms of Cardiac Rehabilitation seem to be equally effective for improving the clinical and health-related quality of life outcomes in low risk patients after MI or revascularisation, or with heart failure. This finding, together with the absence of evidence of important differences in healthcare costs between the two approaches, supports the continued expansion of evidence-based, home-based Cardiac Rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme should reflect the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based Cardiac Rehabilitation reported in these short-term trials can be confirmed in the longer term. A number of studies failed to give sufficient detail to assess their risk of bias.
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exercise based Cardiac Rehabilitation in heart transplant recipients
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lindsey Anderson, Tricia T Nguyen, Christian Have Dall, Laura Burgess, Charlene Bridges, Rod S TaylorAbstract:BACKGROUND:Heart transplantation is considered to be the gold standard treatment for selected patients with end-stage heart disease when medical therapy has been unable to halt progression of the underlying pathology. Evidence suggests that aerobic exercise training may be effective in reversing the pathophysiological consequences associated with Cardiac denervation and prevent immunosuppression-induced adverse effects in heart transplant recipients. OBJECTIVES:To determine the effectiveness and safety of exercise-based Rehabilitation on the mortality, hospital admissions, adverse events, exercise capacity, health-related quality of life, return to work and costs for people after heart transplantation. SEARCH METHODS:We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO) and Web of Science Core Collection (Thomson Reuters) to June 2016. We also searched two clinical trials registers and handsearched the reference lists of included studies. SELECTION CRITERIA:We included randomised controlled trials (RCTs) of parallel group, cross-over or cluster design, which compared exercise-based interventions with (i) no exercise control (ii) a different dose of exercise training (e.g. low- versus high-intensity exercise training); or (iii) an active intervention (i.e. education, psychological intervention). The study population comprised adults aged 18 years or over who had received a heart transplant. DATA COLLECTION AND ANALYSIS:Two review authors independently screened all identified references for inclusion based on pre-specified inclusion criteria. Disagreements were resolved by consensus or by involving a third person. Two review authors extracted outcome data from the included trials and assessed their risk of bias. One review author extracted study characteristics from included studies and a second author checked them against the trial report for accuracy. MAIN RESULTS:We included 10 RCTs that involved a total of 300 participants whose mean age was 54.4 years. Women accounted for fewer than 25% of all study participants. Nine trials which randomised 284 participants to receive exercise-based Rehabilitation (151 participants) or no exercise (133 participants) were included in the main analysis. One cross-over RCT compared high-intensity interval training with continued moderate-intensity training in 16 participants. We reported findings for all trials at their longest follow-up (median 12 weeks).Exercise-based Cardiac Rehabilitation increased exercise capacity (VO2peak) compared with no exercise control (MD 2.49 mL/kg/min, 95% CI 1.63 to 3.36; N = 284; studies = 9; moderate quality evidence). There was evidence from one trial that high-intensity interval exercise training was more effective in improving exercise capacity than continuous moderate-intensity exercise (MD 2.30 mL/kg/min, 95% CI 0.59 to 4.01; N = 16; 1 study). Four studies reported health-related quality of life (HRQoL) measured using SF-36, Profile of Quality of Life in the Chronically Ill (PLC) and the World Health Organization Quality Of Life (WHOQoL) - BREF. Due to the variation in HRQoL outcomes and methods of reporting we were unable to meta-analyse results across studies, but there was no evidence of a difference between exercise-based Cardiac Rehabilitation and control in 18 of 21 HRQoL domains reported, or between high and moderate intensity exercise in any of the 10 HRQoL domains reported. One adverse event was reported by one study.Exercise-based Cardiac Rehabilitation improves exercise capacity, but exercise was found to have no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients whose health is stable.There was no evidence of statistical heterogeneity across trials for exercise capacity and no evidence of small study bias. The overall risk of bias in included studies was judged as low or unclear; more than 50% of included studies were assessed at unclear risk of bias with respect to allocation concealment, blinding of outcome assessors and declaration of conflicts of interest. Evidence quality was assessed as moderate according to GRADE criteria. AUTHORS' CONCLUSIONS:We found moderate quality evidence suggesting that exercise-based Cardiac Rehabilitation improves exercise capacity, and that exercise has no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients. Cardiac Rehabilitation appears to be safe in this population, but long-term follow-up data are incomplete and further good quality and adequately-powered trials are needed to demonstrate the longer-term benefits of exercise on safety and impact on both clinical and patient-related outcomes, such as health-related quality of life, and healthcare costs.
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Cardiac Rehabilitation for people with heart disease an overview of cochrane systematic reviews
Cochrane Database of Systematic Reviews, 2014Co-Authors: Lindsey Anderson, Rod S TaylorAbstract:Background Overviews are a new approach to summarising evidence and synthesising results from related systematic reviews. Objectives To conduct an overview of Cochrane systematic reviews to provide a contemporary review of the evidence for delivery of Cardiac Rehabilitation, to identify opportunities for merging or splitting existing Cochrane reviews, and to identify current evidence gaps to inform new Cardiac Rehabilitation systematic review titles. Methods We searched The Cochrane Database of Systematic Reviews (2014, Issue 10) to identify systematic reviews that addressed the objectives of this overview. We assessed the quality of included reviews using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) measurement tool and the quality of the evidence for reported outcomes using the GRADE framework. The focus of the data presentation was descriptive with detailed tabular presentations of review level and trial level characteristics and results. Main results We found six Cochrane systematic reviews and judged them to be of high methodological quality. They included 148 randomised controlled trials (RCTs) in 98,093 participants. Compared with usual care alone, the addition of exercise-based Cardiac Rehabilitation in low-risk people after myocardial infarction or percutaneous coronary intervention or with heart failure appeared to have no impact on mortality, but did reduce hospital admissions and improved health-related quality of life. Psychological- and education-based interventions alone appeared to have little or no impact on mortality or morbidity but may have improved health-related quality of life. Home- and centre-based programmes were equally effective in improving quality of life outcomes at similar healthcare costs. Selected interventions can increase the uptake of Cardiac Rehabilitation programmes whilst there is currently only weak evidence to support interventions that improve adherence to Cardiac Rehabilitation programmes. The quality of the primary RCTs in the included systematic reviews was variable, and limitations in the methodological quality of the RCTs led to downgrading of the quality of the evidence, which varied widely by review and by outcome. Authors' conclusions Exercise-based Cardiac Rehabilitation is an effective and safe therapy to be used in the management of clinically stable people following myocardial infarction or percutaneous coronary intervention or who have heart failure. Future RCTs of Cardiac Rehabilitation need to improve their reporting methods and reflect the real world practice better including the recruitment of higher risk people and consideration of contemporary models of Cardiac Rehabilitation delivery, and identify effective interventions for enhancing adherence to Rehabilitation.
Neil Oldridge - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of Cardiac Rehabilitation after conventional heart valve surgery versus usual care
European Journal of Preventive Cardiology, 2017Co-Authors: Patrick Doherty, Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Anndorthe Zwisler, Tina Birgitte Hansen, Jakob Kjellberg, Neil OldridgeAbstract:Background While Cardiac Rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of Cardiac Rehabilitation following heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to Cardiac Rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of Cardiac Rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac Rehabilitation after heart valve surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of Cardiac Rehabilitation.
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Cardiac Rehabilitation patient and organizational factors what keeps patients in programs
Journal of the American Heart Association, 2013Co-Authors: Karam Turkadawi, Neil Oldridge, Sergey Tarima, William B Stason, Donald S ShepardAbstract:Background-—Despite documented benefits of Cardiac Rehabilitation, adherence to programs is suboptimal with an average dropout rate of between 24% and 50%. The goal of this study was to identify organizational and patient factors associated with Cardiac Rehabilitation adherence. Methods and Results-—Facilities of the Wisconsin Cardiac Rehabilitation Outcomes Registry Project (N=38) were surveyed and records of 4412 enrolled patients were analyzed. Generalized estimating equations were used to account for clustering of patients within facilities. The results show that organizational factors associated with significantly increased adherence were relaxation training and diet classes (group and individual formats) and group-based psychological counseling, medication counseling, and lifestyle modification, the medical director’s presence in the Cardiac Rehabilitation activity area for ≥15 min/week, assessment of patient satisfaction, adequate space, and adequate equipment. Patient factors associated with significantly increased adherence were aged ≥65 years, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) high-risk category, having received coronary artery bypass grafting, and diabetes disease. Non-white race was negatively associated with adherence. There was no significant gender difference in adherence. None of the baseline patient clinical profiles were associated with adherence including body mass index, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and blood pressure. Conclusions-—Factors associated with adherence to Cardiac Rehabilitation included both organizational and patient factors. Modifiable organizational factors may help directors of Cardiac Rehabilitation programs improve patient adherence to this beneficial program. (J Am Heart Assoc. 2013;2:e000418 doi: 10.1161/JAHA.113.000418)
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motivational counselling for physical activity in patients with coronary artery disease not participating in Cardiac Rehabilitation
European Journal of Preventive Cardiology, 2012Co-Authors: Robert D Reid, Neil Oldridge, Lyall Higginson, Louise Morrin, Andreas Wielgosz, Chris M Blanchard, Louise J Beaton, Chantal Nelson, Lisa Mcdonnell, George A WellsAbstract:Background: Many patients with coronary artery disease (CAD) fail to attend Cardiac Rehabilitation following acute coronary events because they lack motivation to exercise. Theory-based approaches to promote physical activity among non-participants in Cardiac Rehabilitation are required.Design: A randomized trial comparing physical activity levels at baseline, 6, and 12 months between a motivational counselling (MC) intervention group and a usual care (UC) control group.Method: One hundred and forty-one participants hospitalized with acute coronary syndromes not planning to attend Cardiac Rehabilitation were recruited at a single centre and randomized to either MC (n = 69) or UC (n = 72). The MC intervention, designed from an ecological perspective, included one face-to-face contact and eight telephone contacts with a trained physiotherapist over a 52-week period. The UC group received written information about starting a walking programme and brief physical activity advice from their attending cardiologi...
Kirstine Laerum Sibilitz - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of Cardiac Rehabilitation after conventional heart valve surgery versus usual care
European Journal of Preventive Cardiology, 2017Co-Authors: Patrick Doherty, Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Anndorthe Zwisler, Tina Birgitte Hansen, Jakob Kjellberg, Neil OldridgeAbstract:Background While Cardiac Rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of Cardiac Rehabilitation following heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to Cardiac Rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of Cardiac Rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac Rehabilitation after heart valve surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of Cardiac Rehabilitation.
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Cardiac Rehabilitation increases physical capacity but not mental health after heart valve surgery a randomised clinical trial
Heart, 2016Co-Authors: Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Signe Stelling Risom, Trine Bernholdt Rasmussen, Lars Hermann TangAbstract:Objective The evidence for Cardiac Rehabilitation after valve surgery remains sparse. Current recommendations are therefore based on patients with ischaemic heart disease. The aim of this randomised clinical trial was to assess the effects of Cardiac Rehabilitation versus usual care after heart valve surgery. Methods The trial was an investigator-initiated, randomised superiority trial (The CopenHeart VR trial, VR; valve replacement or repair). We randomised 147 patients after heart valve surgery 1:1 to 12 weeks of Cardiac Rehabilitation consisting of physical exercise and monthly psycho-educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO 2 peak and secondary outcome was self-reported mental health measured by Short Form-36. Results 76% were men, mean age 62 years, with aortic (62%), mitral (36%) or tricuspid/pulmonary valve surgery (2%). Cardiac Rehabilitation compared with control had a beneficial effect on VO 2 peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40) or the exploratory physical and mental outcomes. Cardiac Rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02). Conclusions Cardiac Rehabilitation after heart valve surgery significantly improves VO 2 peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. Further research is needed to justify Cardiac Rehabilitation in this patient group. Trial registration number NCT01558765, Results.
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home based versus centre based Cardiac Rehabilitation
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lindsey Anderson, Georgina A Sharp, Rebecca J Norton, Hasnain M Dalal, Sarah Dean, Kate Jolly, Aynsley Cowie, Anna Zawada, Rod S TaylorAbstract:Background Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based Cardiac Rehabilitation programmes are offered to individuals after Cardiac events to aid recovery and prevent further Cardiac illness. Home-based Cardiac Rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review originally published in 2009. Objectives To compare the effect of home-based and supervised centre-based Cardiac Rehabilitation on mortality and morbidity, health-related quality of life, and modifiable Cardiac risk factors in patients with heart disease. Search methods To update searches from the previous Cochrane review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 9, 2014), MEDLINE (Ovid, 1946 to October week 1 2014), EMBASE (Ovid, 1980 to 2014 week 41), PsycINFO (Ovid, 1806 to October week 2 2014), and CINAHL (EBSCO, to October 2014). We checked reference lists of included trials and recent systematic reviews. No language restrictions were applied. Selection criteria Randomised controlled trials (RCTs) that compared centre-based Cardiac Rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction (MI), angina, heart failure or who had undergone revascularisation. Data collection and analysis Two authors independently assessed the eligibility of the identified trials and data were extracted by a single author and checked by a second. Authors were contacted where possible to obtain missing information. Main results Seventeen trials included a total of 2172 participants undergoing Cardiac Rehabilitation following an acute MI or revascularisation, or with heart failure. This update included an additional five trials on 345 patients with heart failure. Authors of a number of included trials failed to give sufficient detail to assess their potential risk of bias, and details of generation and concealment of random allocation sequence were particularly poorly reported. In the main, no difference was seen between home- and centre-based Cardiac Rehabilitation in outcomes up to 12 months of follow up: mortality (relative risk (RR) = 0.79, 95% confidence interval (CI) 0.43 to 1.47, P = 0.46, fixed-effect), Cardiac events (data not poolable), exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.29 to 0.08, P = 0.29, random-effects), modifiable risk factors (total cholesterol: mean difference (MD) = 0.07 mmol/L, 95% CI -0.24 to 0.11, P = 0.47, random-effects; low density lipoprotein cholesterol: MD = -0.06 mmol/L, 95% CI -0.27 to 0.15, P = 0.55, random-effects; systolic blood pressure: mean difference (MD) = 0.19 mmHg, 95% CI -3.37 to 3.75, P = 0.92, random-effects; proportion of smokers at follow up (RR = 0.98, 95% CI 0.79 to 1.21, P = 0.83, fixed-effect), or health-related quality of life (not poolable). Small outcome differences in favour of centre-based participants were seen in high density lipoprotein cholesterol (MD = -0.07 mmol/L, 95% CI -0.11 to -0.03, P = 0.001, fixed-effect), and triglycerides (MD = -0.18 mmol/L, 95% CI -0.34 to -0.02, P = 0.03, fixed-effect, diastolic blood pressure (MD = -1.86 mmHg; 95% CI -0.76 to -2.95, P = 0.0009, fixed-effect). In contrast, in home-based participants, there was evidence of a marginally higher levels of programme completion (RR = 1.04, 95% CI 1.01 to 1.07, P = 0.009, fixed-effect) and adherence to the programme (not poolable). No consistent difference was seen in healthcare costs between the two forms of Cardiac Rehabilitation. Authors' conclusions This updated review supports the conclusions of the previous version of this review that home- and centre-based forms of Cardiac Rehabilitation seem to be equally effective for improving the clinical and health-related quality of life outcomes in low risk patients after MI or revascularisation, or with heart failure. This finding, together with the absence of evidence of important differences in healthcare costs between the two approaches, supports the continued expansion of evidence-based, home-based Cardiac Rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme should reflect the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based Cardiac Rehabilitation reported in these short-term trials can be confirmed in the longer term. A number of studies failed to give sufficient detail to assess their risk of bias.
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home based Cardiac Rehabilitation compared with centre based Rehabilitation and usual care a systematic review and meta analysis
International Journal of Cardiology, 2006Co-Authors: Kate Jolly, Rod S Taylor, Gregory Y H Lip, Andrew StevensAbstract:Abstract Background To determine the effectiveness of home-based Cardiac Rehabilitation programmes compared with (i) usual care and (ii) supervised centre-based Cardiac Rehabilitation on mortality, health related quality of life and modifiable Cardiac risk factors of patients with coronary heart disease. Methods Systematic review and meta-analysis of randomised controlled trials. Main outcome measures: mortality, smoking cessation, exercise capacity, systolic blood pressure, total cholesterol, psychological status, and health related quality of life. Results Eighteen included trials for home versus usual Rehabilitation and six trials of home versus supervised centre-based Rehabilitation were identified. The home-based interventions were clinically heterogeneous, trials often small, with quality poorly reported. Compared with usual care, home-based Cardiac Rehabilitation had a 4 mm Hg (95% CI 6.5, 1.5) greater reduction in systolic blood pressure, and a reduced relative risk of being a smoker at follow-up (RR 0.71, 95% CI 0.51, 1.00). Differences in exercise capacity, total cholesterol, anxiety and depression were all in favour of the home-based group. In patients post-myocardial infarction exercise capacity was significantly improved in the home Rehabilitation group by 1.1 METS (95% CI 0.2, 2.1) compared to usual care. The comparison of home-based with supervised centre-based Cardiac Rehabilitation revealed no significant differences in exercise capacity, systolic blood pressure and total cholesterol. Conclusions Current evidence does not show home-based Cardiac Rehabilitation to be significantly inferior to centre-based Rehabilitation for low-risk Cardiac patients. However, the numbers of patients included are less than 750 and ongoing trials will contribute to the debate on the acceptability, effectiveness and cost-effectiveness of home-based Cardiac Rehabilitation.