Impact of program duration and contact frequency on efficacy and cost of cardiac rehabilitation: results of a randomized trial.
BACKGROUND
Secondary prevention through cardiac rehabilitation (CR) has been recommended for most patients with coronary artery disease (CAD). Although generally reimbursed for 3 months, to date, optimal CR program duration and frequency of patient contact has yet to be identified. This study compared standard (33 sessions for 3 months) versus distributed (33 sessions for 12 months) CR for effects on exercise variables, risk factors, health-related quality of life (HRQL), depressive symptoms, and direct costs to the cardiac health care system.


METHODS
We randomly assigned 392 patients to either standard CR (n = 196) or distributed CR (n = 196). Outcomes were cardiorespiratory fitness, daily physical activity, coronary risk factors, generic and heart disease HRQL, and depressive symptoms, measured 12 and 24 months after program intake. Secondary outcomes included these variables measured after 3 months. Costs to the cardiac health care system were determined 2 years after program initiation.


RESULTS
Both groups showed improvements over time in cardiorespiratory fitness, daily physical activity, low-density lipoprotein cholesterol, generic and heart disease HRQL, and depressive symptoms. Over time, blood pressure and body mass index values worsened. Smoking status, high-density lipoprotein cholesterol, and triglyceride levels remained unchanged. There were no clinically meaningful or statistically significant between group differences for outcomes at 12 or 24 months. The costs of the programs to the cardiac health care system were not different.


CONCLUSIONS
From a clinical standpoint, this study indicates that both standard and distributed program formats serve patients with CAD equally well over the longer term. Programs could use either program delivery model (standard or distributed) depending on patient or program needs. Costs to the cardiac health care system are similar.
Reid
Robert D
RD
Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. breid@ottawaheart.ca
Dafoe
William A
WA
Morrin
Louise
L
Mayhew
Alain
A
Papadakis
Sophia
S
Beaton
Louise
L
Oldridge
Neil B
NB
Coyle
Douglas
D
Wells
George A
GA
D000368:Aged; D001521:Behavior Therapy; D003327:Coronary Disease / Q000534:rehabilitation*; D003376:Counseling; D005081:Exercise Therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation; D011788:Quality of Life; D012046:Rehabilitation / Q000191:economics; D012307:Risk Factors; D012944:Social Support; D013997:Time Factors