A short course of cardiac rehabilitation program is highly cost effective in improving long-term quality of life in patients with recent myocardial infarction or percutaneous coronary intervention.
OBJECTIVE
To evaluate the long-term effect of a cardiac rehabilitation and prevention program (CRPP) on quality of life (QOL) and its cost effectiveness.


METHODS
Prospective, randomized controlled trial.


METHODS
University-affiliated outpatient cardiac rehabilitation and prevention center.


METHODS
A total of 269 patients (76% men; mean age, 64+/-11 y) with recent acute myocardial infarction (AMI; n=193) or after elective percutaneous coronary intervention (PCI; n=76) were randomized in a ratio of 2 to 1.


METHODS
Patients received either CRPP (an 8-wk exercise and education class in phase 2) or conventional therapy without exercise program (control group). They were followed until they had completed all 4 phases of the program (ie, 2 y).


METHODS
QOL assessments, by using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Symptoms Questionnaire, were performed at the end of each phase. Direct health care cost was calculated, whereas cost utility was estimated as money spent (in US dollars) per quality-adjusted life-year (QALY) gained.


RESULTS
In the CRPP group, 6 of the 8 SF-36 dimensions improved significantly by phase 2 and were maintained throughout the study period. Patients were less anxious and depressed, and felt more relaxed and contented. In the control group, none of the SF-36 dimensions were improved by phase 2, and bodily pain was increased. In phase 4, only 4 dimensions were improved. Symptoms were unchanged except for increased hostility score. There was a significant gain in net time trade-off in the CRPP group after phase 2. The direct health care expenses in the CRPP and control groups were 15,292 dollars and 15,707 dollars per patient, respectively. Therefore, the cost utility calculated was 640 dollars saved per QALY gained. Savings attributable to CRPP were primarily explained by the lower rate (13% vs 26% of patients, chi2 test=3.9, P <.05) and cost of subsequent PCI (P =.01).


CONCLUSIONS
In an era of managing patients with coronary heart disease, a short-course CRPP was highly cost effective in providing better QOL to patients with recent AMI or after elective PCI. In addition, the improvement of QOL was quick and sustained for at least 2 years after CRPP.
Yu
Cheuk-Man
CM
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong.
Lau
Chu-Pak
CP
Chau
June
J
McGhee
Sarah
S
Kong
Shun-Ling
SL
Cheung
Bernard Man-Yung
BM
Li
Leonard Sheung-Wai
LS
D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000523:psychology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010353:Patient Education as Topic / Q000191:economics*; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years