title: A five-year rehabilitation programme for younger women after a coronary event reduces the need for hospital care.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) is the dominant diagnosis in in-patient care in Sweden and the third most common cause for long-term sick leave and disability pension. Women are higher consumers of health care than men and have higher frequencies of sickness absenteeism. The aim of this paper was to evaluate whether a five-year long rehabilitation programme for women with CVD affected the use of hospital care and sickness absenteeism.
  
  
  METHODS
  130 women below 65 years of age with CVD were randomized to either intervention (n = 69, mean age 52.4 years) with an intensive lifestyle programme (e.g. physical exercise, smoking cessation, dietary advice), including stress management or to standard care (n = 61, mean age 54.3 years). All patients went through baseline medical examinations, including self-administered questionnaires. This procedure was repeated yearly during the rehabilitation period. The frequency of cardiac-related healthcare use was followed via official registers.
  
  
  RESULTS
  Emergency visits and number of in-patient days decreased significantly in the intervention group from year one to year five (p < 0.05) but remained unchanged in the control group. Scheduled doctor visits decreased significantly in both groups. There were no significant differences between groups regarding proportion of women on sick leave after one, three and five years.
  
  
  CONCLUSIONS
  This extensive intervention programme reduced visits at emergency wards and numbers of in-patient days, which in the long run may have beneficial effects on public finances and the patient's quality of life. The study confirmed previous findings from interventions showing difficulties in influencing sick-leave rates.
authors.affiliation: Karolinska University Hospital, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Andersson
authors.forename: Kristina Lindwall
authors.initials: KL
authors.lastname: Sundel
authors.forename: Anna-Lena
authors.initials: AL
authors.lastname: Undén
authors.forename: Karin
authors.initials: K
authors.lastname: Schenck-Gustafsson
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Eriksson
mesh_terms: D000041:Absenteeism; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000523:psychology; D003327:Coronary Disease / Q000517:prevention & control / Q000523:psychology / Q000534:rehabilitation; D017046:Cost Savings; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010343:Patient Admission; D011446:Prospective Studies; D011788:Quality of Life; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013997:Time Factors