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The Birmingham Rehabilitation Uptake Maximisation study (BRUM): a randomised controlled trial comparing home-based with centre-based cardiac rehabilitation
  1. Kate Jolly (c.b.jolly{at}bham.ac.uk)
  1. University of Birmingham, United Kingdom
    1. Gregory YH Lip (g.y.h.lip{at}bham.ac.uk)
    1. City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
      1. Rod S Taylor (r.s.taylor{at}pms.ac.uk)
      1. Peninsula Medical School, University of Exeter, United Kingdom
        1. James P Raftery (j.p.raftery{at}soton.ac.uk)
        1. University of Southampton, United Kingdom
          1. J W Mant (j.w.mant{at}bham.ac.uk)
          1. University of Birmingham, United Kingdom
            1. Deirdre Lane (deirdre.lane{at}swbh.nhs.uk)
            1. City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
              1. Sheila Greenfield (s.m.greenfield{at}bham.ac.uk)
              1. University of Birmingham, United Kingdom
                1. Andrew Stevens (a.j.stevens{at}bham.ac.uk)
                1. University of Birmingham, United Kingdom

                  Abstract

                  Objective To compare the outcomes of home-based (using the Heart Manual) and centre-based cardiac rehabilitation programmes.

                  Design Randomised controlled trial & 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 (SBP, DBP), total (TC)- and HDL-cholesterol, psychological status (HADS anxiety and depression) and exercise capacity (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 was compared with the centre-based programme at 12 months. Adjusted mean difference (95% CI) for SBP was 1.94 mmHg (-1.1, 5.0); DBP 0.42 mmHg (-1.25, 2.1); TC 0.1 mmol/l (-0.05, 0.24); HADS anxiety - 0.02 (-0.69, 0.65); HADS depression - 0.35 (-0.95, 0.25); distance on ISWT - 21.5m (-48.3, 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 198GBP, (95% CIs 189GBP to 208GBP) compared to 157GBP (95% CIs 139GBP to 175GBP) in 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 UK. This study is registered as ISRCTN72884263.

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