Clinical InvestigationPrevention and RehabilitationHospital-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☆
Section snippets
Methods
The methods of this pragmatic, open, single-center, centrally randomized, parallel group trial have been presented in detail elsewhere.16 Our hypothesis was that CCR was significantly more beneficial than UC regarding primary and secondary outcome measures (see below). We briefly describe the method here.
Study population
Among 1,614 eligible patients, 770 (47%) consented to participate. The 844 nonparticipants were older (P < .001), had more often CHF (P = .04), and had less often IHD (P < .001) than participants. Adjusted for age and comorbidity, mortality was almost twice as high among the nonparticipants as compared with the participants at 12 months (relative risk 1.87, 95% confidence interval [CI] 1.19-2.85).
Of the 770 participants, 91 (12%) had CHF, 446 (58%) IHD, and 233 (30%) HR; 380 patients were
Main findings
Our trial demonstrated that CCR can be safely delivered to a motivated, broadly defined group of patients with CHF, IHD, and HR attending the same program. Comprehensive cardiac rehabilitation did not significantly affect the composite primary outcome compared with UC during the 12 months. The lack of effect may be due to the low number of patients included, too short follow-up, or too small ‘a dose’ of CCR. We found that CCR patients had significantly shorter length of stay during readmissions
Conclusion
At 12 months, the CCR and UC groups did not differ regarding the primary composite outcome: death, MI, or acute first-time readmission due to heart disease. Comprehensive cardiac rehabilitation was associated with a significant reduction in length of hospital stay and improved cardiac risk factors.
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Financial support was granted by Copenhagen Hospital Corporation Research Council, Danish Heart Foundation, Danish Pharmacy Foundation of 1991, Danish Research Council, Danish Center for Evaluation and Health Technology Assessment, Denmark's Ministry of the Interior and Health, Development Fund of Copenhagen County, Villadsen Family Foundation, Eva and Henry Frænkel's Memorial Foundation, Builder LP Christensen's Foundation, Danish Animal Protection Foundation, Bristol Meyers Squibb, Merck Sharp and Dohme, AstraZeneca, The Copenhagen Trial Unit, and Bispebjerg Hospital.
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Listed at www.CardiacRehabilitation.dk.