Jump to comment:

• Cardiac rehabilitation supports a heterogeneous population of patients
  W. Robert Williams
  Published on: 23 November 2015

• Published on: 23 November 2015

  Cardiac rehabilitation supports a heterogeneous population of patients

  • W. Robert Williams, senior lecturer
  • Other Contributors:
    • Jackie Austin

  In a recent publication reporting the outcome of a trial, West et al conclude that comprehensive cardiac rehabilitation (CR) following MI has no important effect on mortality, morbidity, risk factors or health related quality of life (HRQL).1 Trial results provided evidence, consistent with that from meta-analysis of post 1983 data, for a decline in the need for CR resulting from advances in patient management.

  ...

  Show More

  In a recent publication reporting the outcome of a trial, West et al conclude that comprehensive cardiac rehabilitation (CR) following MI has no important effect on mortality, morbidity, risk factors or health related quality of life (HRQL).1 Trial results provided evidence, consistent with that from meta-analysis of post 1983 data, for a decline in the need for CR resulting from advances in patient management.

  Although the authors prefer to place their faith in the findings of one large study and selected systematic reviews, the value of a large trial can be constrained by a narrow range of patient and intervention parameters. In the study of West et al, patients are generally not old, nor afflicted by anxiety and depression and not greatly at risk (mortality rates of 6% and 17% at one and five years, respectively). 1 There was no short term analysis of the 6-8 week rehabilitation programme until 12 months, at which time the assessments identified similar health outcomes in both groups. In terms of the intervention, one could question how effective is CR when the control arm demonstrates a significant increase in exercise at 12 months.

  In our small trial of CR for elderly patients with heart failure, a higher proportion of the intervention group (71% versus 51%) were still exercising after 5 years.2 Analysed at 5 years, on the basis of exercise /no exercise (rather than on the original trial arms) there were very significant differences in favour of the exercise group for physical, emotional and quality of life scores. Although it is obvious that patients in the exercise group have functional capacity and motivation, they may not have reached this status of better health without enrolling on a CR programme.

  We note that subsequent analyses of CR data for coronary heart disease strengthen the positive outcomes of CR for reducing cardiovascular mortality and morbidity.3 An updated review of systolic heart failure following hospital-based CR also finds important reductions in hospital admissions and improvements in quality of life. 4

  1. West RR, Jones DA, Henderson AH. Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction. Heart (2011). doi:10.1136/heartjnl-2011-300302. 2. Austin J, Williams WR, Hutchison S. Exercise profile as a 5 year determinant of physical health and well-being in a cohort of heart failure patients. Cardiovascular Continuum 2011; 2: 1-5. 3. Heran BS, Chen JM, Ebrahim S et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011; (7) CD001800. 4. Davies EJ, Moxham T, Rees K et al. Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev 2010; (4) CD003331.

  Conflict of Interest:

  None declared

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top