title: Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263].
abstract: BACKGROUND
  Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation.
  
  
  METHODS
  A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting.
  
  
  METHODS
  We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation.
  
  
  METHODS
  Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity.In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence.
  
  
  CONCLUSIONS
  More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation Uptake Maximisation Study (BRUM) study and has implications for the clinical management of these patients. A novel feature of this study is the inclusion of non-English Punjabi speakers.
authors.affiliation: Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom. C.B.Jolly@bham.ac.uk
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Josie
authors.initials: J
authors.lastname: Sandercock
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Greenfield
authors.forename: James P
authors.initials: JP
authors.lastname: Raftery
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.forename: Rod
authors.initials: R
authors.lastname: Taylor
authors.forename: Deirdre
authors.initials: D
authors.lastname: Lane
authors.forename: Kaeng Wai
authors.initials: KW
authors.lastname: Lee
authors.forename: A J
authors.initials: AJ
authors.lastname: Stevens
mesh_terms: D016507:Cardiology Service, Hospital; D003362:Cost-Benefit Analysis; D006699:Home Care Services; D006801:Humans; D015337:Multicenter Studies as Topic / Q000379:methods*; D009203:Myocardial Infarction / Q000208:ethnology / Q000534:rehabilitation*; D009204:Myocardial Revascularization / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design; D016896:Treatment Outcome; D006113:United Kingdom