title: Plasma haemostatic markers, endothelial function and ambulatory blood pressure changes with home versus hospital cardiac rehabilitation: the Birmingham Rehabilitation Uptake Maximisation Study.
abstract: BACKGROUND
  Cardiac rehabilitation is an accepted therapeutic intervention in patients after myocardial infarction or coronary revascularisation. The effects of cardiac rehabilitation programmes, whether home based or hospital based, on haemostatic indices (as reflected by fibrinogen, plasma viscosity, fibrin D-dimer (an index of thrombogenesis), von Willebrand factor (vWf, an index of endothelial damage/dysfunction), soluble P-selectin (an index of platelet activation)), vasomotor function (using flow-mediated dilatation (FMD)) and ambulatory blood pressure (ABP) in patients with coronary heart disease are unknown.
  
  
  METHODS
  81 patients (66 men, mean (SD) 59 (11) years) after myocardial infarction or coronary revascularisation were randomised to comprehensive hospital-based (n = 40) or home-based (n = 41) cardiac rehabilitation. Plasma levels of vWf, D-dimer, fibrinogen, soluble P-selectin and plasma viscosity, as well as FMD and 24-h ABP, were measured at baseline and after 3 months of cardiac rehabilitation.
  
  
  RESULTS
  In patients who completed cardiac rehabilitation, levels of vWf, fibrinogen and D-dimer were significantly lower and FMD improved (all p<or=0.001), whereas levels were unchanged in controls. Significant reductions were also observed in 24-h mean systolic blood pressure, diastolic blood pressure and mean aortic pressure after completion of cardiac rehabilitation (all p<0.05). No significant differences were observed between the hospital-based and home-based cardiac rehabilitation programmes on these indices.
  
  
  CONCLUSIONS
  Cardiac rehabilitation improves haemostasis, endothelial function and ABP in patients with coronary heart disease, with no significant differences between home-based and hospital-based cardiac rehabilitation programmes. These effects may contribute to the beneficial effects of cardiac rehabilitation programmes on CV outcomes.
authors.affiliation: Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK.
authors.forename: K W
authors.initials: KW
authors.lastname: Lee
authors.forename: A D
authors.initials: AD
authors.lastname: Blann
authors.forename: K
authors.initials: K
authors.lastname: Jolly
authors.forename: G Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D001794:Blood Pressure; D004730:Endothelium, Vascular / Q000503:physiopathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006487:Hemostasis / Q000502:physiology; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000534:rehabilitation*; D011446:Prospective Studies; D014666:Vasomotor System / Q000503:physiopathology
chemical_list: D008055:Lipids