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Correspondence
‘FIT FOR PURPOSE’. The COACH program improves lifestyle and biomedical cardiac risk factors
  1. Michael V Jelinek1,2,
  2. John D Santamaria1,2,
  3. David R Thompson3,
  4. Margarite J Vale2,4
  1. 1St Vincent's Hospital, Melbourne, Australia
  2. 2Department of Medicine, University of Melbourne, Melbourne, Australia
  3. 3Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia
  4. 4The COACH Program, Managing Director of the COACH Program, University of Melbourne, Melbourne, Australia
  1. Correspondence to Dr Michael V Jelinek, 55 Victoria Parade, Fitzroy, Victoria 3065, Australia; jelinem{at}bigpond.com

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Introduction

The ‘Rehabilitation after Myocardial Infarction Trial’ (RAMIT) showed that cardiac rehabilitation in the UK failed to impact on total mortality, cardiac morbidity, health related quality of life and behavioural risk factors.1 These results were met with indignation. David Wood actually questioned whether cardiac rehabilitation as performed in the UK was ‘fit for purpose’.2 Which raises the question: what is the purpose of cardiac rehabilitation? We believe that the immediate objectives of cardiac rehabilitation are to improve the physical fitness of cardiac patients after acute illness or cardiac procedures and to initiate secondary prevention by improving lifestyle and biomedical risk factors. Nowadays, patients spend 2–4 days in hospital after an acute coronary syndrome. They are not deconditioned. They are fit to return to work 2–4 weeks after the acute event. They are unlikely to attend a cardiac rehabilitation programme which starts weeks after the acute event and might delay their return to work. But these patients do need to be equipped for secondary prevention. The Coaching patients On Achieving Cardiovascular Health (COACH) Program is a telephone delivered coaching programme which contacts patients either in hospital or by phone immediately after their discharge from hospital: to educate them, to empower them to relate better to their treating doctor(s), and to set goals for guideline recommended individual cardiac risk factors, both lifestyle and biomedical. It has been shown to be superior to usual medical care in two randomised controlled trials.3 ,4

Methods and results

This study compared the status of lifestyle and biomedical cardiac risk factors at entry and exit from The COACH Program. The results were included for each risk factor if recorded both at entry and exit from The COACH Program. Five thousand five hundred and forty-four patients discharged from cardiology units or cardiac surgery units after treatment for acute coronary syndromes or stable angina. The patients all underwent a secondary prevention programme, The COACH Program, delivered by telephone. The results of this programme are shown in the table 1.

Table 1

Comparison of coronary risk factor status at entry and exit from The COACH Program

In summary, there was an improvement in all risk factors measured. These include lifestyle risk factors—smoking status, waist measurement, body weight, alcohol intake and physical activity; and biomedical risk factors—total fasting cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol, systolic and diastolic blood pressure, fasting blood glucose and HbA1c in patients with diabetes.

Discussion

Despite systematic reviews which show that exercise based cardiac rehabilitation lowers all cause death rates, deaths from cardiac disease and improves cardiac risk factor status, RAMIT showed that cardiac rehabilitation, as usually performed, did not have any impact on any of these factors.1 Furthermore, attendance at cardiac rehabilitation remains poor and has not improved in the last 10 years.5 This is not surprising given the short stay in hospital after an acute coronary syndrome and the opportunity to return to usual work 2–4 weeks after admission to hospital. However, ‘patients not attending cardiac rehabilitation after an acute coronary syndrome have more adverse risk factor profiles and poorer knowledge of risk factors compared with those about to commence cardiac rehabilitation’.6 This paper has shown that The COACH Program has improved the lifestyle and biomedical risk factors which are implicated in the prognosis of coronary heart disease. Unlike cardiac rehabilitation as usually performed, it is fit for purpose in the secondary prevention of coronary heart disease.

References

Footnotes

  • All authors had access to the data and were involved in the writing of the manuscript. This manuscript is submitted as an original paper.

  • Contributors MVJ designed this project, helped with data analysis and the writing of this letter. JDS performed the statistical analysis of the data and contributed to the writing of the letter. DT contributed to the writing of the letter. MJV is the founder and managing director of The COACH Program.

  • Funding This data is self-funded. This work was funded by the COACH Program.

  • Competing interests MVJelinek is honorary medical advisor to The COACH Program; MJV is the Director of The COACH Program which is self-funding; JDS and MT have no financial interests in The COACH Program.

  • Provenance and peer review Not commissioned; internally peer reviewed.