Article

Objective: To evaluate the long-term effect of a cardiac
rehabilitation and prevention program (CRPP) on quality of life
(QOL) and its cost effectiveness.
Design: Prospective, randomized controlled trial.
Setting: University-affiliated outpatient cardiac rehabilitation
and prevention center.
Participants: A total of 269 patients (76% men; mean age,
64
11y) with recent acute myocardial infarction (AMI;
n193) or after elective percutaneous coronary intervention
(PCI; n76) were randomized in a ratio of 2 to 1.
Intervention: Patients received either CRPP (an 8-wk exercise
and education class in phase 2) or conventional therapy
without exercise program (control group). They were followed
until they had completed all 4 phases of the program (ie, 2y).
Main Outcome Measures: QOL assessments, by using the
Medical Outcomes Study 36-Item Short-Form Health Survey
(SF-36) and Symptoms Questionnaire, were performed at the
end of each phase. Direct health care cost was calculated,
whereas cost utility was estimated as money spent (in US$) per
quality-adjusted life-year (QALY) gained.
Results: In the CRPP group, 6 of the 8 SF-36 dimensions
improved significantly by phase 2 and were maintained
throughout the study period. Patients were less anxious and
depressed, and felt more relaxed and contented. In the control
group, none of the SF-36 dimensions were improved by phase
2, and bodily pain was increased. In phase 4, only 4 dimensions
were improved. Symptoms were unchanged except for increased
hostility score. There was a significant gain in net time
trade-off in the CRPP group after phase 2. The direct health
care expenses in the CRPP and control groups were $15,292 calculated was $640 saved per QALY gained. Savings attributable
to CRPP were primarily explained by the lower rate
(13% vs 26% of patients,
2 test3.9, P.05) and cost of
subsequent PCI (P.01).
Conclusions: In an era of managing patients with coronary
heart disease, a short-course CRPP was highly cost effective in
providing better QOL to patients with recent AMI or after
elective PCI. In addition, the improvement of QOL was quick
and sustained for at least 2 years after CRPP.

Langue : ANGLAIS