Authors' objectives:

"The study aimed to evaluate the relative effectiveness and cost-effectiveness of a home-based programme of cardiac rehabilitation using the Heart Manual, with centre-based programmes in patients who have experienced a myocardial infarction (MI) or coronary revascularisation within the previous 12 weeks. In addition, it sought to explore the reasons for non-adherence to cardiac rehabilitation programmes."

(from executive summary)

Authors' results and conclusions: At all three follow-up points no clinically or statistically significant differences were found in any of the primary outcome measures between the home- and centre-based groups or in any of the secondary outcomes. Significant improvements in total cholesterol, smoking prevalence, the HADS anxiety score, self-reported physical activity and diet were seen in both the home- and centre-based arms between baseline and the 6-month follow-up. Five or more contacts with a cardiac rehabilitation nurse were received by 96% of participants in the home-based arm, whereas only 56% of participants in the centre-based arm attended this many rehabilitation classes (p < 0.001). The direct rehabilitation costs to the health service were significantly higher for the home-based programme; the mean cost was 198 [95% confidence interval (CI) 189 to 208] versus 157 (95% CI 139 to 175), p < 0.05, for the centre-based programme. When patient costs were included, the mean cost of the centre-based arm rose to 182 (difference not significant). The programme at Hospital 1 had a significantly higher mean cost than that for Hospital 2 or Hospitals 3 and 4 combined. Patients' reasons for not taking up or adhering to cardiac rehabilitation were multifactorial and very individual. Other health problems, such as arthritis, and continuing cardiac problems limited some patients' ability to exercise. The majority of non-adherers found some aspects of their cardiac rehabilitation programme helpful. Many had adapted advice on rehabilitation and were continuing to exercise in other ways and had made lifestyle changes, particularly to their diet. On the home-based programme, patients' lack of motivation to exercise on their own at home was a major factor in non-adherence. The focus groups revealed little diversity of views among patients from each programme. In particular, patients in the hospital programme enjoyed the camaraderie of group exercise and the home-based patients valued the wealth of information and advice in the Heart Manual.

Authors' recommendations: For low- to moderate-risk patients following MI, percutaneous transluminal coronary angioplasty or coronary artery bypass graft, a home-based cardiac rehabilitation programme does not produce inferior outcomes compared with the traditional centre-based programmes. With the level of home visiting in this trial, the home-based programme was more costly to the health service, but with the difference in costs borne by patients attending centre-based programmes. Reasons for non-participation/non-adherence were multifactorial and individualistic, with in most cases one critical factor that determined eventual cardiac rehabilitation behaviour. There were differences in the reasons given by home and hospital cardiac rehabilitation patients, with home-based patients often citing a lack of motivation to exercise at home. Social characteristics, individual patient needs and the location of cardiac rehabilitation programmes need to be taken into account in programme design to maximise participation.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1210

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

Copyright: 2009 Queen's Printer and Controller of HMSO