RESUMEN
BACKGROUND: In recent decades, several studies have assessed the value of cardiac rehabilitation as secondary prevention and have reported substantial reductions in readmissions. However, conclusive evidence is scarce. The present study aims to evaluate the efficacy of a supervised exercise training program for improving percentages of hospital readmission for cardiac causes in patients with myocardial ischemia in the first year after a cardiac event. The effect on all-cause readmission, all-cause mortality, functional capacity, quality of life and adherence to regular exercise is also discussed. METHODS/DESIGN: This study will be conducted as a randomized controlled trial. Eligible patients will be randomly assigned to a control group receiving standard care or to an intervention group which, in addition to standard care, will take part in a supervised exercise training program consisting of three hours a week (spread over three alternate days) of supervised exercise training for 10 weeks. Both groups will perform an exercise stress test and a blood test during the first and third month after hospital discharge. The follow-up period will be 12 months after hospital discharge. The primary outcome measures will be the percentage of patients readmitted, total number of readmissions and length of hospitalization for cardiac disease during the first year after hospital discharge, and time to first hospital admission for cardiac disease. DISCUSSION: A representative group of hospitalized patients after myocardial ischemia will be studied in order to provide comprehensive data on the potential impact of a supervised exercise training program on hospital readmission rates. TRIAL REGISTRATION: Current Controlled Trials ISRCTN57634424.
Asunto(s)
Terapia por Ejercicio/métodos , Isquemia Miocárdica/terapia , Readmisión del Paciente/estadística & datos numéricos , Causas de Muerte , Evaluación de la Discapacidad , Prueba de Esfuerzo , Humanos , Tiempo de Internación , Cooperación del Paciente , Educación del Paciente como Asunto , Calidad de Vida , Prevención SecundariaRESUMEN
BACKGROUND: The results of research into the outcomes of physical rehabilitation and its relationship with post-myocardial ischaemia survival and readmissions are inconclusive. Our primary aim was to evaluate the efficacy of a supervised exercise training programme in terms of decreasing hospital cardiac readmission in patients with myocardial ischaemia. METHODS: We conducted a randomised controlled trial including patients with myocardial ischaemia. Eligible patients were assigned to a control group receiving standard care or to an intervention group that took part in a supervised exercise training programme. The follow-up period was 12 months after hospital discharge. RESULTS: Of 478 patients assessed for eligibility, 86 were randomised to the control group ( n = 44) or the intervention group ( n = 42). Cardiac readmission rates were 14% versus 5% ( p = 0.268) in the control and intervention groups, respectively, and all-cause readmission rates were 23% versus 15% ( p = 0.34). There were no deaths in either group. More control patients were treated in the emergency services (50% vs. 24%; p = 0.015). In terms of health-related quality of life, patients in the intervention group presented with significant increases in functional capacity and mobility. More intervention patients returned to work (77.3% vs. 36.0%; p = 0.005). CONCLUSIONS: The supervised physical exercise programme was effective at reducing the number of emergency room visits and at increasing the percentage of patients who returned to work. It also improved patients' exercise capacity and increased their health-related quality of life. Although the results were promising, the programme was not associated with a significant reduction in cardiac and all-cause readmission rates.