title: Effectiveness of three models for comprehensive cardiovascular disease risk reduction.
abstract: Cost and accessibility contribute to low participation rates in phase 2 cardiac rehabilitation programs in the United States. In this study, we compared the clinical effectiveness of 2 less costly and potentially more accessible approaches to cardiovascular risk reduction with that of a contemporary phase 2 cardiac rehabilitation program. Low- or moderate-risk patients (n = 155) with coronary artery disease (CAD) were randomly assigned to 12 weeks of participation in a contemporary phase 2 cardiac rehabilitation program (n = 52), a physician supervised, nurse-case-managed cardiovascular risk reduction program (n = 54), or a community-based cardiovascular risk reduction program administered by exercise physiologists guided by a computerized participant management system based on national clinical guidelines (n = 49). In all, 142 patients (91.6%) completed testing at baseline and after 12 weeks of intervention. For patients with abnormal (i.e., not at the goal level) baseline values, statistically significant (p < or =0.05) improvements were observed with all 3 interventions for multiple CAD risk factors. No statistically significant risk factor differences were observed among the 3 programs. For patients with a baseline maximal oxygen uptake < 7 metabolic equivalents, cardiorespiratory fitness increased to a greater degree in patients in the cardiac rehabilitation program and the community-based program versus the physician-supervised, nurse- case-managed program. These data have important implications for cost containment and increasing accessibility to clinically effective comprehensive cardiovascular risk reduction services in low- or moderate-risk patients with CAD.
authors.affiliation: Center for Heart Disease Prevention, St. Joseph's/Candler Health System, Savannah, Georgia 31405, USA. ngordon@interventusa.com
authors.forename: Neil F
authors.initials: NF
authors.lastname: Gordon
authors.forename: Carla D
authors.initials: CD
authors.lastname: English
authors.forename: Aashish S
authors.initials: AS
authors.lastname: Contractor
authors.forename: Richard D
authors.initials: RD
authors.lastname: Salmon
authors.forename: Richard F
authors.initials: RF
authors.lastname: Leighton
authors.forename: Barry A
authors.initials: BA
authors.lastname: Franklin
authors.forename: William L
authors.initials: WL
authors.lastname: Haskell
mesh_terms: D003327:Coronary Disease / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D026761:Physical Therapy Specialty; D015397:Program Evaluation; D012046:Rehabilitation / Q000191:economics / Q000458:organization & administration*; D012307:Risk Factors; D016896:Treatment Outcome; D000078329:Workforce