Long-term effects of integrated rehabilitation in patients with advanced angina pectoris: a nonrandomized comparative study.
OBJECTIVE
An evaluation of Integrative Rehabilitation (IR) of patients with angina pectoris with respect to death rate, the need for invasive treatment, and cost effectiveness.


METHODS
A report from a clinical database. Death rates were compared to those of the general Danish population matched for age, gender, and observation period, as well as with data from the literature concerning medical and invasive treatments.


METHODS
The treatment was carried out as an ambulatory treatment in a private clinic.


METHODS
One hundred and sixty-eight (168) patients with angina pectoris, of whom 103 were candidates for invasive treatment and 65 for whom this had been rejected.


METHODS
Integrated rehabilitation consists of acupuncture, a self-care program including acupressure, Chinese health philosophy, stress management techniques, and lifestyle adjustments.


METHODS
Death rate from any cause, the need for invasive treatment, and health care expenses.


RESULTS
The 3-year accumulated risk of death was 2.0% (95% confidence limits: 0.0%-4.7%) for the 103 candidates for invasive treatment, 6.4% for the general Danish population, 5.4% (4.7%-6.1%), and 8.4% (7.7%-9.1%) for patients who underwent percutaneous transluminal balloon angioplasty and coronary artery bypass grafting, respectively, in New York. For the 65 inoperable patients the risk of death due to heart disease was 7.7% (3.9%-11.5%), compared to 16% (10%-34%) and 25% (18%-36%) for American patients, who were treated with laser revascularization or medication, respectively. Of the 103 candidates for invasive treatment, only 19 (18%) still required surgery. Cost savings over 3 years were US 36,000 dollars and US 22,000 dollars for surgical and nonsurgical patients, respectively. These were mainly achieved by the reduction in the use of invasive treatment and a 95% reduction in in-hospital days.


CONCLUSIONS
Integrated rehabilitation was found to be cost effective, and added years to the lives of patients with severe angina pectoris. The results invite further testing in a randomized trial.
Ballegaard
Soeren
S
The Ballegaard Acupuncture Center, Klampenborg, Denmark. sb@drballegaard.com
Borg
E
E
Karpatschof
B
B
Nyboe
J
J
Johannessen
A
A
D019050:Acupressure / Q000191:economics; D015670:Acupuncture Therapy / Q000191:economics; D000368:Aged; D000787:Angina Pectoris / Q000191:economics / Q000401:mortality / Q000534:rehabilitation*; D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000191:economics; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics; D003718:Denmark; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008516:Medicine, Chinese Traditional / Q000191:economics; D008875:Middle Aged; D012648:Self Care / Q000191:economics; D013315:Stress, Psychological / Q000150:complications*; D015996:Survival Rate