Objective: To compare the outcomes of home-based (using the Heart Manual) and centre-based cardiac rehabilitation programmes.
Design: Randomised controlled trial and parallel economic evaluation.
Setting: Predominantly inner-city, multi-ethnic population in the West Midlands, England.
Patients: 525 patients referred to four hospitals for cardiac rehabilitation following myocardial infarction or coronary revascularisation.
Interventions: A home-based cardiac rehabilitation programme compared with centre-based programmes.
Main outcome measures: Smoking cessation, blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), total cholesterol (TC) and high-density lipoprotein (HDL)-cholesterol, psychological status (HADS anxiety and depression) and exercise capacity (incremental shuttle walking test, ISWT) measured at 12 months. Health service resource use, quality of life utility and costs were quantified.
Results: There were no significant differences in the main outcomes when the home-based was compared with the centre-based programme at 12 months. Adjusted mean difference (95% CI) for SBP was 1.94 mm Hg (−1.1 to 5.0); DBP 0.42 mm Hg (−1.25 to 2.1); TC 0.1 mmol/l (−0.05 to 0.24); HADS anxiety −0.02 (−0.69 to 0.65); HADS depression −0.35 (−0.95 to 0.25); distance on ISWT −21.5 m (−48.3 to 5.2). The relative risk of being a smoker in the home arm was 0.90. The cost per patient to the NHS was significantly higher in the home arm at £198, (95% CI 189 to 208) compared to £157 (95% CI 139 to 175) in the centre-based arm. However when the patients’ cost of travel was included, these differences were no longer significant.
Conclusions A home-based cardiac rehabilitation programme does not produce inferior outcomes when compared to traditional centre-based programmes as provided in the United Kingdom.
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▸ Additional tables are published online only at http://heart.bmj.com/content/vol95/issue1
Funding: The project wishes to acknowledge that this study is funded by the UK Department of Health through its Health Technology Assessment Programme. National Heart Research funded the development of the Heart Manual for patients following a revascularisation procedure.
Competing interests: None.
This study is registered as ISRCTN72884263.
The opinions and conclusions expressed here are those of the authors and do not necessarily reflect those of the UK National Health Service or the Department of Health. The sponsors had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data and final responsibility for the decision to submit for publication.
HADS copyright, RP Snaith and AS Zigmond, 1983, 1992, 1994. Record forms originally published in Acta Psychiatrica Scandinavica;67:361–70, copyright Munksgaard International Publishers Ltd, Copenhagen 1983. Reproduced by permission of the publishers, nferNelson Publishing Company Ltd, of The Chiswick Centre, 414 Chiswick High Road, London W4 5TF UK. All rights reserved including translation. nferNelson is a division of Granada Learning Limited, part of ITV plc.