Expanded Cardiac Rehabilitation in Socially Vulnerable Patients with Myocardial Infarction: a 10-year Follow-up Study Focusing on Mortality and Non-fatal Events

Overview

Journal BMJ Open

Specialty General Medicine

Date 2018 Jan 25

PMID 29362268

Citations 7

Authors

Kathrine Hald

Kirsten Melgaard Nielsen

Claus Vinther Nielsen

Lucette Kirsten Meillier

Finn Breinholt Larsen

Bo Christensen

Mogens Lytken Larsen

Affiliations

Soon will be listed here.

Abstract

Objective: Cardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socially differentiated CR intervention and examine the impact of the intervention on all-cause mortality, cardiovascular mortality, non-fatal recurrent events and major cardiac events (MACE) 10 years after.

Design: Prospective cohort study.

Setting: The cardiac ward at a university hospital in Denmark from 2000 to 2004.

Participants: 379 patients aged <70 years admitted with first episode myocardial infarction (MI). The patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and their social network. A complete follow-up was achieved.

Intervention: A socially differentiated CR intervention. The intervention consisted of standard CR and additionally a longer phase II course, more consultations, telephone follow-up and a better handover to phase III CR in the municipal sector, in general practice and in the patient association.

Main Outcome Measures: All-cause mortality, cardiovascular mortality, non-fatal recurrent events and MACE.

Results: There was no significant difference in all-cause mortality (OR: 1.29, 95% CI 0.58 to 2,89), cardiovascular mortality (OR: 0.80, 95% CI 0.31 to 2.09), non-fatal recurrent events (OR:1.62, 95% CI 0.67 to 3.92) or MACE (OR: 1.31, 95% CI 0.53 to 2.42) measured at 10-year follow-up when comparing the expanded CR intervention to standard CR.

Conclusions: Despite the significant results of the socially differentiated CR intervention at 1-year follow-up, no long-term effects were seen regarding the main outcome measures at 10-year follow-up. Future research should focus on why it is not possible to lower the mortality and morbidity significantly among socially vulnerable patients admitted with first episode MI.

Citing Articles

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.

Beleigoli A, Dafny H, Pinero de Plaza M, Hutchinson C, Marin T, Ramos J Clin Rehabil. 2024; 38(6):837-854.

PMID: 38631370 PMC: 11059835. DOI: 10.1177/02692155241236998.

Socioeconomic and ethnical disparity in coronary heart disease outcomes in Denmark and the effect of cardiac rehabilitation-A nationwide registry study.

Kjesbu I, Prescott E, Rasmusen H K H, Osler M, Larsen M, Gustafsson I PLoS One. 2022; 17(11):e0276768.

PMID: 36342928 PMC: 9639811. DOI: 10.1371/journal.pone.0276768.

Enhancing participation in cardiac rehabilitation: Focus on underserved populations.

Ades P, Khadanga S, Savage P, Gaalema D Prog Cardiovasc Dis. 2022; 70:102-110.

PMID: 35108567 PMC: 9119375. DOI: 10.1016/j.pcad.2022.01.003.

Is the Clinical Delivery of Cardiac Rehabilitation in an Australian Setting Associated with Changes in Physical Capacity and Cardiovascular Risk and Are Any Changes Maintained for 12 Months?.

Price K, Gordon B, Bird S, Benson A Int J Environ Res Public Health. 2021; 18(17).

PMID: 34501541 PMC: 8431287. DOI: 10.3390/ijerph18178950.

Cardiac rehabilitation via telerehabilitation in COVID-19 pandemic situation.

Sari D, Wijaya L Egypt Heart J. 2021; 73(1):31.

PMID: 33779873 PMC: 8006124. DOI: 10.1186/s43044-021-00156-7.

References

Kachur S, Chongthammakun V, Lavie C, De Schutter A, Arena R, Milani R . Impact of cardiac rehabilitation and exercise training programs in coronary heart disease. Prog Cardiovasc Dis. 2017; 60(1):103-114. DOI: 10.1016/j.pcad.2017.07.002. View

Anderson L, Oldridge N, Thompson D, Zwisler A, Rees K, Martin N . Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2016; 67(1):1-12. DOI: 10.1016/j.jacc.2015.10.044. View

Piepoli M, Corra U, Dendale P, Frederix I, Prescott E, Schmid J . Challenges in secondary prevention after acute myocardial infarction: A call for action. Eur J Prev Cardiol. 2016; 23(18):1994-2006. DOI: 10.1177/2047487316663873. View

Lavie C, Menezes A, De Schutter A, Milani R, Blumenthal J . Impact of Cardiac Rehabilitation and Exercise Training on Psychological Risk Factors and Subsequent Prognosis in Patients With Cardiovascular Disease. Can J Cardiol. 2016; 32(10 Suppl 2):S365-S373. DOI: 10.1016/j.cjca.2016.07.508. View

Rasmussen J, Rasmussen S, Gislason G, Buch P, Abildstrom S, Kober L . Mortality after acute myocardial infarction according to income and education. J Epidemiol Community Health. 2006; 60(4):351-6. PMC: 2566173. DOI: 10.1136/jech.200X.040972. View

Blumenthal J, Sherwood A, Smith P, Watkins L, Mabe S, Kraus W . Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial. Circulation. 2016; 133(14):1341-50. PMC: 4824555. DOI: 10.1161/CIRCULATIONAHA.115.018926. View

Grace S, Turk-Adawi K, Contractor A, Atrey A, Campbell N, Derman W . Cardiac Rehabilitation Delivery Model for Low-Resource Settings: An International Council of Cardiovascular Prevention and Rehabilitation Consensus Statement. Prog Cardiovasc Dis. 2016; 59(3):303-322. DOI: 10.1016/j.pcad.2016.08.004. View

Pluss C, Billing E, Held C, Henriksson P, Kiessling A, Karlsson M . Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study. Clin Rehabil. 2010; 25(1):79-87. DOI: 10.1177/0269215510376006. View

Molshatzki N, Drory Y, Myers V, Goldbourt U, Benyamini Y, Steinberg D . Role of socioeconomic status measures in long-term mortality risk prediction after myocardial infarction. Med Care. 2011; 49(7):673-8. DOI: 10.1097/MLR.0b013e318222a508. View

10.

Mikkelsen T, Thomsen K, Tchijevitch O . Non-attendance and drop-out in cardiac rehabilitation among patients with ischaemic heart disease. Dan Med J. 2014; 61(10):A4919. View

11.

Laustsen S, Hjortdal V, Petersen A . Predictors for not completing exercise-based rehabilitation following cardiac surgery. Scand Cardiovasc J. 2013; 47(6):344-51. DOI: 10.3109/14017431.2013.859295. View

12.

Notara V, Panagiotakos D, Papataxiarchis E, Verdi M, Michalopoulou M, Tsompanaki E . Depression and marital status determine the 10-year (2004-2014) prognosis in patients with acute coronary syndrome: the GREECS study. Psychol Health. 2015; 30(9):1116-27. DOI: 10.1080/08870446.2015.1034720. View

13.

Piepoli M, Hoes A, Agewall S, Albus C, Brotons C, Catapano A . 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Rev Esp Cardiol (Engl Ed). 2016; 69(10):939. DOI: 10.1016/j.rec.2016.09.009. View

14.

Giannuzzi P, Temporelli P, Marchioli R, Maggioni A, Balestroni G, Ceci V . Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network. Arch Intern Med. 2008; 168(20):2194-204. DOI: 10.1001/archinte.168.20.2194. View

15.

Melgaard Nielsen K, Meillier L, Larsen M . Extended cardiac rehabilitation for socially vulnerable patients improves attendance and outcome. Dan Med J. 2013; 60(3):A4591. View

16.

Korda R, Soga K, Joshy G, Calabria B, Attia J, Wong D . Socioeconomic variation in incidence of primary and secondary major cardiovascular disease events: an Australian population-based prospective cohort study. Int J Equity Health. 2016; 15(1):189. PMC: 5117581. DOI: 10.1186/s12939-016-0471-0. View

17.

Martensson S, Gyrd-Hansen D, Prescott E, Andersen P, Gislason G, Jacobsen R . Does access to invasive examination and treatment influence socioeconomic differences in case fatality for patients admitted for the first time with non-ST-elevation myocardial infarction or unstable angina?. EuroIntervention. 2015; 11(13):1495-502. DOI: 10.4244/EIJY15M09_06. View

18.

Stirbu I, Looman C, Nijhof G, Reulings P, Mackenbach J . Income inequalities in case death of ischaemic heart disease in the Netherlands: a national record-linked study. J Epidemiol Community Health. 2012; 66(12):1159-66. DOI: 10.1136/jech-2011-200924. View

19.

Janssen V, De Gucht V, Dusseldorp E, Maes S . Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2012; 20(4):620-40. DOI: 10.1177/2047487312462824. View

20.

Smolina K, Wright F, Rayner M, Goldacre M . Long-term survival and recurrence after acute myocardial infarction in England, 2004 to 2010. Circ Cardiovasc Qual Outcomes. 2012; 5(4):532-40. DOI: 10.1161/CIRCOUTCOMES.111.964700. View