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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Prognostic effects of cardiovascular rehabilitation: facts and myths
Elena Exposito Ordóñez1, Diego Roldán Conesa1, Tomás Vicente Vera2,3
1Cardiac Rehabilitation Unit, Reina Sofia de Murcia University Hospital, Murcia, Spain.
Insights
Cardiac rehabilitation programs significantly reduce cardiovascular events and mortality in post-acute coronary syndrome patients. These programs improve risk factor control and promote lifestyle changes for better long-term outcomes.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiac rehabilitation (CR) has shown benefits in cardiovascular morbidity and mortality.
- Previous studies were conducted before widespread use of modern secondary prevention drugs.
- A need exists for standardized CR program evaluation.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary cardiac rehabilitation program (CRHP).
- To assess the impact of CRHP on cardiovascular morbidity, mortality, and recurrent events in patients post-acute cardiovascular event.
- To determine the influence of CRHP on risk factors for cardiovascular disease (RFCV) and lifestyle modifications.
Main Methods:
- A prospective study involving 442 patients within six months of an acute cardiovascular event.
- Comparison between 306 patients in a CRHP group and 136 patients receiving standard cardiology follow-up.
- Median follow-up of 60 months for 405 patients.
Main Results:
- CRHP patients had significantly fewer cardiovascular readmissions (17% vs. 43.38%, P<0.001).
- Major cardiovascular events and revascularizations were lower in the CRHP group (11.9% vs. 27.2%, P<0.001 and 9.3% vs. 21.32%, P=0.001, respectively).
- CRHP led to improved RFCV control (66% vs. 19.85%, P<0.001) and lifestyle changes (91% vs. 61%, P<0.001), with zero cardiovascular mortality versus 2.2% in controls (P=0.014).
Conclusions:
- Multidisciplinary CRHPs are effective in reducing cardiovascular morbidity and mortality.
- CRHPs significantly improve secondary prevention outcomes for coronary patients.
- Standardized CRHP interventions are crucial for optimizing patient recovery and long-term cardiovascular health.
Abstract:
Since CR was introduced, studies have been carried out to discover the effect of CRHPs on cardiovascular morbidity and mortality and on heart-disease patients' quality of life. The first meta-analyses showed improvement in cardiovascular morbidity and mortality, although the studies were conducted in the coronary pre-reperfusion era, before the generalized use in secondary prevention of drugs such as statins, beta-blockers, or renin-angiotensin-system inhibitors, which have produced a decrease in cardiovascular mortality. In Europe, analyzing 25 studies with more than 200,000 patients. It concluded that, in spite of the great heterogeneity of the programs, CR clearly decreases mortality after ACS. Nevertheless, a strategy of CRHP standardization and evaluation is needed. In 2017, a study was carried out in our hospital to evaluate the effectiveness of multidisciplinary CRHP intervention on cardiovascular morbidity and mortality, recurrence of cardiovascular events, the control of RFCV and lifestyle changes in patients after ACS. A total of 442 patients were included who had presented an acute cardiovascular event in the previous six months; 306 patients from the CR group and 136 others with standard cardiology follow-up were used as controls. 405 patients completed follow-up for a median of 60 months. Compared to the usual treatments in cardiology, the patients who underwent CRHPs presented fewer readmissions for cardiovascular reasons (17% vs. 43.38%, P<0.001), fewer major cardiovascular events (11.9% vs. 27.2%, P<0.001) and new revascularizations (9.3% vs. 21.32%, P=0.001), with lower cardiovascular mortality (0 vs. 2.2%, P=0.014). It also led to better control of the RFCV (66% vs. 19.85%, P<0.001) and favored lifestyle changes in these patients (91% vs. 61%, P<0.001). Therefore, in our setting, the performance of CRHPs was shown to be effective in reducing cardiovascular morbidity and mortality and in the secondary prevention of coronary patients.
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