Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation

Schweikert, Bernd; Hahmann, Harry; Steinacker, Jürgen M.; Imhof, Armin; Muche, Rainer; Köenig, Wolfgang; Liu, Yuanyuan; Leidl, Reiner

doi:10.1007/s00392-009-0081-6

Cited by 26 publications

(26 citation statements)

References 25 publications

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“…The only study that evaluated cost-effectiveness between inpatient and outpatient cardiac rehabilitation demonstrated no significant difference [29] (Table 4). …”

Section: Resultsmentioning

confidence: 99%

A systematic review of economic evaluations of cardiac rehabilitation

Wong

Feng²,

Pwee

et al. 2012

BMC Health Serv Res

100

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BackgroundCardiac rehabilitation (CR), a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI), revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF). This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR.MethodsElectronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL) were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond’s checklist.ResultsA total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1) supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2) home-based CR was no different from centre-based CR; (3) no difference existed between inpatient and outpatient CR; and (4) home-based programs were generally cost-saving compared to no CR.ConclusionsOverall, all the studies supported the implementation of CR for MI and HF. However, comparison across studies highlighted wide variability of CR program design and delivery. Policy makers need to exercise caution when generalizing these findings to the Singapore context.

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“…The only study that evaluated cost-effectiveness between inpatient and outpatient cardiac rehabilitation demonstrated no significant difference [29] (Table 4). …”

Section: Resultsmentioning

confidence: 99%

A systematic review of economic evaluations of cardiac rehabilitation

Wong

Feng²,

Pwee

et al. 2012

BMC Health Serv Res

100

View full text Add to dashboard Cite

show abstract

“…Nevertheless, comprehensive advice and support and also the extension of training opportunities and out-patient rehabilitation possibilities would possibly be helpful. Schweikert et al showed that in- and out-patient rehabilitation treatments were of equal benefit for patients following acute coronary illness [28]. Bingisser et al assessed an inexpensive model of out-patient rehabilitation programme for patients with asthma and COPD in Switzerland and demonstrated a positive effect on physical capacity and quality of life [29].…”

Section: Discussionmentioning

confidence: 99%

What patients really think about asthma guidelines: barriers to guideline implementation from the patients’ perspective

Lingner

Burger

Kardos³

et al. 2017

BMC Pulm Med

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BackgroundTreatment of asthma does not always comply with asthma guidelines (AG). This may be rooted in direct or indirect resistance on the doctors’ and/or patients’ side or be caused by the healthcare system. To assess whether patients’ concepts and attitudes are really an implementation barrier for AG, we analysed the patients’ perspective of a “good asthma therapy” and contrasted their wishes with current recommendations.MethodsUsing a qualitative exploratory design, topic centred focus group (FG) discussions were performed until theoretical saturation was reached. Inclusion criteria were an asthma diagnosis and age above 18. FG sessions were recorded audio-visually and analysed via a mapping technique and content analysis performed according to Mayring (supported by MAXQDA®). Participants’ speech times and the proportion of time devoted to different themes were calculated using the Videograph System® and related to the content analysis.ResultsThirteen men and 24 women aged between 20 and 77 from rural and urban areas attended five FG. Some patients had been recently diagnosed with asthma, others years previously or in childhood. The following topics were addressed: (a) concern about or rejection of therapy components, particularly corticosteroids, which sometimes resulted in autonomous uncommunicated medication changes, (b) lack of time or money for optimal treatment, (c) insufficient involvement in therapy choices and (d) a desire for greater empowerment, (e) suboptimal communication between healthcare professionals and (f) difficulties with recommendations conflicting with daily life. Primarily, (g) participants wanted more time with doctors to discuss difficulties and (h) all aspects of living with an impairing condition.ConclusionsWe identified some important patient driven barriers to implementing AG recommendations. In order to advance AG implementation and improve asthma treatment, the patients’ perspective needs to be considered before drafting new versions of AG. These issues should be addressed at the planning stage.Trial registration DRKS00000562 (German Clinical Trials Registry).Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0346-6) contains supplementary material, which is available to authorized users.

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“…FTLD mainly affects neurons of the frontal and temporal lobes (Cairns, et al, 2007), similar to AD, which also exhibits TDP-43 pathology (Amador-Ortiz, et al, 2007). Analysis of cerebrospinal fluid from patients diagnosed with FTLD shows APP fragments, suggesting alteration of APP processing (Schweikert, et al, 2009). The present studies show for the first time that human TDP-43 affects APP processing via increased activity and levels of BACE and cleavage of full length APP, yielding CTF-β and Aβ 1-40 .…”

Section: Discussionmentioning

confidence: 99%

“…Because TDP-43 pathology is present in AD, and alteration of APP metabolism is reported in patients with FTLD/ALS (Schweikert, et al, 2009), we generated gene transfer animal models using lentiviral delivery of TDP-43 and Aβ 1-42 into the primary rat motor cortex and examined crosstalk between these proteins. We specifically sought to determine the mechanistic effects of TDP-43 on APP processing, cell death and inflammation.…”

Section: Introductionmentioning

confidence: 99%

Wild type TDP-43 induces neuro-inflammation and alters APP metabolism in lentiviral gene transfer models

Herman

Khandelwal

Rebeck

et al. 2012

Experimental Neurology

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Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation

Abstract: The ratio of mean cost over mean effect difference (incremental cost-effectiveness ratio) indicates dominance of outpatient rehabilitation, but at a considerable statistical uncertainty. However, outpatient rehabilitation cannot be rejected from an economic perspective.

Cited by 26 publications

References 25 publications

A systematic review of economic evaluations of cardiac rehabilitation

A systematic review of economic evaluations of cardiac rehabilitation

What patients really think about asthma guidelines: barriers to guideline implementation from the patients’ perspective

Wild type TDP-43 induces neuro-inflammation and alters APP metabolism in lentiviral gene transfer models

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