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Effectiveness of three models for comprehensive cardiovascular disease risk reduction
Neil F Gordon1, Carla D English, Aashish S Contractor
1Center for Heart Disease Prevention, St. Joseph's/Candler Health System, Savannah, Georgia 31405, USA. ngordon@interventusa.com
Insights
Two alternative cardiovascular risk reduction programs showed similar effectiveness to traditional cardiac rehabilitation for coronary artery disease patients. These accessible programs offer cost-effective options for improving heart health.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Services Research
Background:
- Low participation in phase 2 cardiac rehabilitation is linked to cost and accessibility issues in the US.
- Effective cardiovascular risk reduction is crucial for patients with coronary artery disease (CAD).
Purpose of the Study:
- To compare the clinical effectiveness of two less costly, more accessible cardiovascular risk reduction programs against a standard phase 2 cardiac rehabilitation program.
- To evaluate the impact of different program models on CAD risk factors and cardiorespiratory fitness.
Main Methods:
- 155 low- to moderate-risk CAD patients were randomized into three 12-week groups: contemporary cardiac rehabilitation, physician-supervised nurse-case-managed program, or community-based program with exercise physiologists and computerized guidance.
- Clinical effectiveness was assessed by measuring changes in CAD risk factors and cardiorespiratory fitness (maximal oxygen uptake).
Main Results:
- All three interventions led to statistically significant improvements in multiple CAD risk factors for patients with abnormal baseline values.
- No significant differences in risk factor improvements were found among the three programs.
- Cardiorespiratory fitness increased more significantly in the cardiac rehabilitation and community-based programs compared to the physician-supervised, nurse-case-managed program for patients with lower baseline fitness.
Conclusions:
- Less costly and more accessible cardiovascular risk reduction programs are clinically effective for low- to moderate-risk CAD patients.
- These findings support the expansion of alternative models to improve cost containment and accessibility of comprehensive cardiovascular care.
Abstract:
Cost and accessibility contribute to low participation rates in phase 2 cardiac rehabilitation programs in the United States. In this study, we compared the clinical effectiveness of 2 less costly and potentially more accessible approaches to cardiovascular risk reduction with that of a contemporary phase 2 cardiac rehabilitation program. Low- or moderate-risk patients (n = 155) with coronary artery disease (CAD) were randomly assigned to 12 weeks of participation in a contemporary phase 2 cardiac rehabilitation program (n = 52), a physician supervised, nurse-case-managed cardiovascular risk reduction program (n = 54), or a community-based cardiovascular risk reduction program administered by exercise physiologists guided by a computerized participant management system based on national clinical guidelines (n = 49). In all, 142 patients (91.6%) completed testing at baseline and after 12 weeks of intervention. For patients with abnormal (i.e., not at the goal level) baseline values, statistically significant (p < or =0.05) improvements were observed with all 3 interventions for multiple CAD risk factors. No statistically significant risk factor differences were observed among the 3 programs. For patients with a baseline maximal oxygen uptake < 7 metabolic equivalents, cardiorespiratory fitness increased to a greater degree in patients in the cardiac rehabilitation program and the community-based program versus the physician-supervised, nurse- case-managed program. These data have important implications for cost containment and increasing accessibility to clinically effective comprehensive cardiovascular risk reduction services in low- or moderate-risk patients with CAD.