Maintenance of Gains, Morbidity, and Mortality at 1 Year Following Cardiac Rehabilitation in a Middle‐Income Country: A Wait‐List Control Crossover Trial

Abstract

Background Despite the epidemic of cardiovascular diseases in middle‐income countries, few trials are testing the benefits of cardiac rehabilitation ( CR ). This trial assessed (1) maintenance of functional capacity, risk factor control, knowledge, and heart‐health behaviors and (2) mortality and morbidity at 6 months following CR in a middle‐income country. Methods and Results Eligible Brazilian coronary patients were initially randomized (1:1:1 concealed) to 1 of 3 parallel arms (comprehensive CR [exercise plus education], exercise‐only CR , or wait‐list control). The CR programs were 6 months in duration, at which point follow‐up assessments were performed. Mortality and morbidity were ascertained from chart and patient or family report (blinded). Controls were then offered CR (crossover). Outcomes were again assessed 6 months later (blinded). ANCOVA was performed for each outcome at 12 months. Overall, 115 (88.5%) patients were randomized, and 62 (53.9%) were retained at 1 year. At 6 months, 23 (58.9%) of those 39 initially randomized to the wait‐list control elected to attend CR . Functional capacity, risk factors, knowledge, and heart‐health behaviors were maintained from 6 to 12 months in participants from both CR arms (all P >0.05). At 1 year, knowledge was significantly greater with comprehensive CR at either time point ( P <0.001). There were 2 deaths. Hospitalizations ( P =0.03), nonfatal myocardial infarctions ( P =0.04), and percutaneous coronary interventions ( P =0.03) were significantly fewer with CR than control at 6 months. Conclusions CR participation is associated with lower morbidity, long‐term maintenance of functional capacity, risk factors, and heart‐health behaviors, as well as with greater cardiovascular knowledge compared with no CR . Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02575976.

Translation and evaluation of a comprehensive educational program for cardiac rehabilitation patients in Latin America: A multi-national, longitudinal study

“…Consistent with prior studies on structured educational interventions for cardiac patients [ 14 , 16 , 31 , 32 ], our findings confirm their benefit in supporting patients’ adherence to CR programs, and increasing knowledge and behaviour change as well, but in a Spanish-speaking setting for the first time to our knowledge. Previous studies have also demonstrated an effect of this education intervention on lower morbidity up to 12 months later in LMICs [ 33 ], which could be cost-saving to health systems, as well as on improvements in cardiorespiratory fitness [ 14 ], which is associated with lower mortality. The results of this study are also particularly encouraging considering previous studies have shown that improvements achieved during CR are not well-maintained in the short- and long-term, including exercise [ 34 , 35 ] and diet [ 36 ]; we found no decay through 6 months.…”

“…However, we tested the association between number of sessions attended and knowledge, and the significant association suggests the intervention was effective. Moreover, our randomized controlled trial with the Portuguese version demonstrated exposure to the education intervention resulted in improvements in several outcomes, over and above both usual care and exercise alone [ 15 , 33 ]. In addition, without a comparison or control group, we cannot rule out practice effects for the knowledge and health literacy scales.…”

Effectiveness of an Education Intervention Among Cardiac Rehabilitation Patients in Canada: A Multi-Site Study

“…Our research group has developed and pilot tested an evidence- and theoretically based comprehensive education intervention 17 that incorporates the use of manuals, patient-oriented didactics, online tools, and a small-group format. 18 This intervention has been tested in a low- and middle-income setting and was shown to improve clinical outcomes, 19 change healthy behaviours, 20 increase disease-related knowledge, 20 and decrease morbidity, 21 with maintenance of gains 1 year after CR. Accordingly, the objective of this study was to assess the effectiveness of an education intervention in improving knowledge and health behaviours among CR patients in 3 sites in Canada.…”

Comparison of cardiac rehabilitation (exercise + education), exercise only, and usual care for patients with coronary artery disease: A non‐randomized retrospective analysis

“…Cardiovascular diseases are the leading cause of morbidity and mortality and are the leading burdens of diseases 1 . Dyslipidemia, high blood pressure, obesity, diabetes, smoking, psychosocial stress, less fruit and vegetable intake, alcohol consumption, and less physical activity are the main risk factors for myocardial infarction in Chinese men and women 2 .…”

“…Cardiac rehabilitation is an outpatient model of secondary prevention and is designed to reduce the burdens of cardiovascular diseases 6 . Cardiac rehabilitation includes the education of patients and exercises 1,6 . Cardiac rehabilitation plays an important role in the management of the risk factors and prognosis for patients after acute myocardial infarction 7,8 .…”