plasma haemostatic markers, endothelial function and ambulatory blood pressure changes with home versus hospital cardiac rehabilitation The Birmingham Rehabilitation Uptake Maximisation Study (BRUM)

Kaeng Lee ¹, Andrew Blann ¹, Kate Jolly ¹ and Gregory Y H Lip ^1*

¹ City Hospital, Birmingham, United Kingdom

^* To whom correspondence should be addressed. E-mail: g.y.h.lip{at}bham.ac.uk.

Accepted 2 June 2006

Abstract

Background: Cardiac rehabilitation (CR) is an accepted therapeutic intervention in patients post-myocardial infarction (MI) or coronary revascularisation. The effects of CR programmes, whether home-based or hospital-based, on haemostatic indices [as reflected by fibrinogen, plasma viscosity (PV) fibrin D-Dimer (an index of thrombogenesis), 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 BP (ABP) in patients with CHD are unknown. Methods: 81 patients (66 male, 59¡À11 yrs) who were post MI or coronary revascularisation were randomised to comprehensive hospital-based (n=40) or home-based (n=41) CR. Plasma levels of vWf, D-Dimer, fibrinogen, soluble P-selectin (sP-sel) and PV, as well as FMD and 24-h ABP were measured at baseline and after 3 months of CR. Results: In patients who completed CR, levels of vWf, fibrinogen and D-Dimer were significantly lower and FMD improved (all p¡Ü0.001), whilst levels were unchanged in controls. There were also significant reductions in 24-hr mean SBP, DBP and MAP after completion of CR (all p<0.05). There were no significant differences between the hospital-based and home-based CR programmes on these indices. Conclusions: CR improves haemostasis, endothelial function and ABP in patients with CHD, with no significant differences between home- and hospital-based CR programmes. These effects may contribute to the beneficial effects of CR programmes on CV outcomes.

Keywords: cardiac rehabilitation, endothelial function, haemostasis

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