This economic evaluation is based on a 5-year follow-up study comparing a comprehensive cardiac rehabilitation programme with standard care after myocardial infarction (MI). The intervention group consisted of 147 non-selected MI patients aged less than 65 years, who were participating in a rehabilitation programme consisting of follow-up at a post-MI clinic, health education and physical training in out-patient groups. The control group consisted of a non-selected MI-population aged less than 65 years (n = 158), who were receiving standard care. The rehabilitation programme did not increase the health-care costs of post-MI care, as the increase in cost due to participation in the programme was balanced by a decrease in readmissions for cardiovascular diseases. On average, the rehabilitated patient returned to work more frequently, resulting in decreased costs due to loss of production. The mean patient total cost of a 5-year MI follow-up was SEK 73,500 lower in the rehabilitated group. The outstanding winner of the rehabilitation programme was the Swedish National Health Insurance System (NHIS). It must be concluded that the comprehensive cardiac rehabilitation programme is a major strategy that leads to both lowered costs and positive health effects. The cardiac rehabilitation programme is therefore highly cost-effective.
To evaluate the long-term secondary preventive effect of a comprehensive rehabilitation programme after coronary artery bypass grafting (CABG).
The study group included 49 consecutive patients who underwent bypass surgery and were then offered a rehabilitation programme consisting of education in risk-factor control, a physical training programme and regular follow-up at a post-CABG clinic. The control group (n = 98), consisting of two well-matched CABG patients for each study patient, was offered the usual care with no access to a cardiac rehabilitation programme. The two groups were followed for 10 years and the results regarding cardiovascular mortality, morbidity, total cardiac events and readmissions to hospital were compared.
The total mortality (study group 8.2%, control group 20.4%) and cardiovascular mortality (8.2 versus 15.3%) after 10 years did not differ significantly between the groups. In the study group, nine patients (18.4%) had 10 cardiac events (four cardiovascular deaths, five non-fatal myocardial infarctions and one CABG) compared to 34 patients (34.7%, P
A community-based long-term cardiac rehabilitation programme (LTP) has been designed for patients who had completed a two-year hospital-based physical training programme after myocardial infarction (MI) and wished to continue with community-based group training sessions. Since the start of LTP 20% of all patients in a consecutive MI population less than 65 yrs have participated. The programme operates on a low-cost base. Its feasibility is supported by a high attendance rate and by the absence of adverse effects during more than 2,000 patient training hours. In order to evaluate LTP 20 participating MI patients were compared with 20 matched control patients, who had completed the hospital-based training, but did not participate in LTP. The main reason for participation was the need for continued group support and social contact (15/20). Reasons for not participating were preference to exercise at home (10/20), long distance (6/20) and working hours (4/20). When compared with the data of the hospital-based programme one year post MI, both groups showed 4 years (average) post MI a slight but significant increase of systolic blood pressure of 12 vs. 18 mmHg. Work performance levels had been maintained (132 vs. 136 W). No patients had started smoking and there were no differences between the groups as to leisure time activities. It is concluded that a long-term training programme can be provided safely and at low cost for those MI patients who need continued support in order to maintain the effectiveness of the hospital-based cardiac rehabilitation.
In a case-control study 49 consecutive post-coronary artery bypass grafting (CABG) patients (10 f, 39 m) participating in a comprehensive rehabilitation programme were compared with 98 individually matched double control patients, receiving standard care. The rehabilitation programme, starting 6 weeks after surgery, consisted of follow-up at a coronary clinic, repeated health education, and physical training in out-patient groups. During the first year after CABG, fewer study group patients were readmitted to hospital (14% vs 32%, p less than 0.01) and on fewer occasions (1.1 vs 2.9, p less than 0.05). Fewer patients used anxiolytic drugs (0% vs 15%, p less than 0.01). At the one year post-CABG exercise test we found in the study group a tendency to a greater increase in work capacity, as compared with the values obtained at the preoperative exercise test (33 vs 25 W ns). There were no differences in the rates of returning to work (59% vs 64%). In a long-term follow-up study (av. 38 months post-CABG) the patients were asked to fill in a questionnaire evaluating perceived physical work capacity and training habits. The study group patients rated their physical work capacity higher, and more patients had continued with regular physical training (66% vs 46%, p = 0.05). There were fewer patients using anxiolytic drugs (9% vs 30%, p less than 0.01). Although the programme did not influence the return to work we conclude that it improved the quality of life of our patients as it entailed fewer readmissions and reduced the use of anxiolytic medication; in addition it promoted physical fitness and training habits.
Regional programs for secondary prevention of coronary artery disease have been under development for nearly a decade in Sweden. To achieve maximum adherence these programs were created in close collaboration between hospital and primary care physicians. The programs are local applications of national guidelines and aim to support compliance among both patients and physicians. In January 1998 the Swedish Society of Cardiology and the Swedish Association of General Practice launched a program for quality control and quality assurance of these initiatives. So far, 51 of 79 districts have joined the program. Patients' diaries used for risk factor registration contain 7 report cards on the management of risk factors and medication. These cards are sent to a central registry upon release from the hospital, after 3-6 months, and annually for 5 years. Results from the first year point to differences between the various districts with respect to compliance with both local programs and European guidelines. Overall, results are promising and indicate that this program is successful and leads to improved management of patients with coronary artery disease.