Cardiac rehabilitation in Austria: long term health-related quality of life outcomes

Abstract

BackgroundThe goal of cardiac rehabilitation programs is not only to prolong life but also to improve physical functioning, symptoms, well-being, and health-related quality of life (HRQL). The aim of this study was to document the long-term effect of a 1-month inpatient cardiac rehabilitation intervention on HRQL in Austria.MethodsPatients (N = 487, 64.7% male, age 60.9 ± 12.5 SD years) after myocardial infarction, with or without percutaneous interventions, coronary artery bypass grafting or valve surgery underwent inpatient cardiac rehabilitation and were included in this long-term observational study (two years follow-up). HRQL was measured with both the MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D].ResultsAll MacNew scale scores improved significantly (p < 0.001) and exceeded the minimal important difference (0.5 MacNew points) by the end of rehabilitation. Although all MacNew scale scores deteriorated significantly over the two year follow-up period (p < .001), all MacNew scale scores still remained significantly higher than the pre-rehabilitation values. The mean improvement after two years in the MacNew social scale exceeded the minimal important difference while MacNew scale scores greater than the minimal important difference were reported by 40-49% of the patients.Two years after rehabilitation the mean improvement in the EQ-5D Visual Analogue Scale score was not significant with no significant change in the proportion of patients reporting problems at this time.ConclusionThese findings provide a first indication that two years following inpatient cardiac rehabilitation in Austria, the long-term improvements in HRQL are statistically significant and clinically relevant for almost 50% of the patients. Future controlled randomized trials comparing different cardiac rehabilitation programs are needed.

Cardiac rehabilitation may not provide a quality of life benefit in coronary artery disease patients

“…Firstly, CR efficacy in relation to impact on HRQoL has been shown to be age-dependent with previous studies reporting that younger (i.e. <41 years) and older (>65 years) patients benefitting the most from CR with no benefits observed in those 41–65 years [21,29]. In this study, the average age of the CR participants was 60 years, which may have influenced the findings.…”

“…In addition, only few studies have used a disease-specific measure, however the choice of instrument has varied, and have included the MacNew [25,26], the Cardiac Quality of Life Index [27], and Quality of Life after Myocardial Infarction [28]. Hofer et al [29] highlights that a consistent application of a single disease-specific measure is warranted in CR research. Although the SAQ is an established and arguably the best disease-specific measure for CAD [13], the present study is the first to utilize the SAQ in a CR setting.…”

The MacNew Heart Disease Health-Related Quality of Life Questionnaire in Patients with Angina and Patients with Ischemic Heart Failure

“…Although some ceiling effect was observed on the social subscale, the minimal floor and ceiling effects on the subscales should permit measurement of change, both deterioration and improvement, in HRQoL. The MacNew consistently has been shown to be responsive after different treatment options in patients with angina, myocardial infarction, or ischemic heart failure such as cardiac rehabilitation [24,[51][52][53][54][55][56], revascularization [57,58], and medication [59], and we see no reason why the MacNew would not be responsive in other patients with angina or ischemic heart failure.…”

Commentary on Yohannes AM, Doherty P, Bundy C & Yalfani A (2010) The long‐term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life. Journal of Clinical Nursing 19, 2806–2813

“…in energy expenditure, the sample size of 105 patients at six and 12 months was inadequate for subgroup analyses. In addition, recent findings from a similar study (Höfer et al. 2010) investigating long‐term outcomes from an comprehensive four‐week cardiac rehabilitation programme ( n = 351 at two years) found a significant short‐term improvement in HRQoL (at one month), yet at two years follow‐up, HRQoL significantly decreased in all of the MacNew scales.…”