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Expanded cardiac rehabilitation in socially vulnerable patients with myocardial infarction: a 10-year follow-up study focusing on mortality and non-fatal events.

ABSTRACT: OBJECTIVE:Cardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socially differentiated CR intervention and examine the impact of the intervention on all-cause mortality, cardiovascular mortality, non-fatal recurrent events and major cardiac events (MACE) 10 years after. DESIGN:Prospective cohort study. SETTING:The cardiac ward at a university hospital in Denmark from 2000 to 2004. PARTICIPANTS:379 patients aged <70 years admitted with first episode myocardial infarction (MI). The patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and their social network. A complete follow-up was achieved. INTERVENTION:A socially differentiated CR intervention. The intervention consisted of standard CR and additionally a longer phase II course, more consultations, telephone follow-up and a better handover to phase III CR in the municipal sector, in general practice and in the patient association. MAIN OUTCOME MEASURES:All-cause mortality, cardiovascular mortality, non-fatal recurrent events and MACE. RESULTS:There was no significant difference in all-cause mortality (OR: 1.29, 95%?CI 0.58 to 2,89), cardiovascular mortality (OR: 0.80, 95%?CI 0.31 to 2.09), non-fatal recurrent events (OR:1.62, 95%?CI 0.67 to 3.92) or MACE (OR: 1.31, 95%?CI 0.53 to 2.42) measured at 10-year follow-up when comparing the expanded CR intervention to standard CR. CONCLUSIONS:Despite the significant results of the socially differentiated CR intervention at 1-year follow-up, no long-term effects were seen regarding the main outcome measures at 10-year follow-up. Future research should focus on why it is not possible to lower the mortality and morbidity significantly among socially vulnerable patients admitted with first episode MI.

SUBMITTER: Hald K

PROVIDER: S-EPMC5786137 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Expanded cardiac rehabilitation in socially vulnerable patients with myocardial infarction: a 10-year follow-up study focusing on mortality and non-fatal events.

Hald Kathrine K Nielsen Kirsten Melgaard KM Nielsen Claus Vinther CV Meillier Lucette Kirsten LK Larsen Finn Breinholt FB Christensen Bo B Larsen Mogens Lytken ML

BMJ open 20180123 1

<h4>Objective</h4>Cardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socia ...[more]

PMID: 29362268

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Project description:BackgroundGiven the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly).ObjectivesThis study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial.MethodsThe trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life-5 Dimensions-5 Level visual analogue scale at 12 weeks.ResultsMACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes).ConclusionsYoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408).

Dataset Information

Expanded cardiac rehabilitation in socially vulnerable patients with myocardial infarction: a 10-year follow-up study focusing on mortality and non-fatal events.

Publications

Expanded cardiac rehabilitation in socially vulnerable patients with myocardial infarction: a 10-year follow-up study focusing on mortality and non-fatal events.

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