Long-term effects of integrated rehabilitation in patients with advanced angina pectoris: a nonrandomized comparative study.

OBJECTIVES: An evaluation of Integrative Rehabilitation (IR) of patients with angina pectoris with respect to death rate, the need for invasive treatment, and cost effectiveness. DESIGN: A report from a clinical database. Death rates were compared to those of the general Danish population matched for age, gender, and observation period, as well as with data from the literature concerning medical and invasive treatments. SETTING: The treatment was carried out as an ambulatory treatment in a private clinic. SUBJECTS: One hundred and sixty-eight (168) patients with angina pectoris, of whom 103 were candidates for invasive treatment and 65 for whom this had been rejected. INTERVENTIONS: Integrated rehabilitation consists of acupuncture, a self-care program including acupressure, Chinese health philosophy, stress management techniques, and lifestyle adjustments. OUTCOME MEASURES: Death rate from any cause, the need for invasive treatment, and health care expenses. RESULTS: The 3-year accumulated risk of death was 2.0% (95% confidence limits: 0.0%-4.7%) for the 103 candidates for invasive treatment, 6.4% for the general Danish population, 5.4% (4.7%-6.1%), and 8.4% (7.7%-9.1%) for patients who underwent percutaneous transluminal balloon angioplasty and coronary artery bypass grafting, respectively, in New York. For the 65 inoperable patients the risk of death due to heart disease was 7.7% (3.9%-11.5%), compared to 16% (10%-34%) and 25% (18%-36%) for American patients, who were treated with laser revascularization or medication, respectively. Of the 103 candidates for invasive treatment, only 19 (18%) still required surgery. Cost savings over 3 years were US 36,000 dollars and US 22,000 dollars for surgical and nonsurgical patients, respectively. These were mainly achieved by the reduction in the use of invasive treatment and a 95% reduction in in-hospital days. CONCLUSIONS: Integrated rehabilitation was found to be cost effective, and added years to the lives of patients with severe angina pectoris. The results invite further testing in a randomized trial.

Addition of acupuncture and self-care education in the treatment of patients with severe angina pectoris may be cost beneficial: an open, prospective study.

OBJECTIVES: A cost-benefit analysis of acupuncture and self-care education in the treatment of patients with angina pectoris. DESIGN: An open prospective study on an unselected group of patients. For comparison of risk three control groups were used: (1) published data concerning medical and invasive treatments; (2) an age- and sex matched group obtained from a randomly selected Danish population of 14,000 people; and (3) the 211 patients in this group with angina pectoris symptoms. SETTING: The treatment was carried out on a outpatient basis in a private research clinic. SUBJECTS: 105 patients with angina pectoris, 73 candidates for invasive treatment, and 32 for whom this was rejected. INTERVENTIONS: Acupuncture and self-care education was added to the pharmaceutical treatment. OUTCOME MEASURES: Healthcare expenses, a satisfactory medical status defined as New York Heart Association (NYHA) classification 0-I and/or no use of antianginal medication, and risk measured as cardiac death or myocardial infarction. RESULTS: The estimated cost savings during 5 years were $32,000 (U.S.) per patient, mainly due to a 90% reduction in hospitalization and 70% reduction in needed surgery. Compared to 8% before treatment, 53% of the patients achieved a life without limitations (NYHA 0-I) 1 year after treatment, as did 69% after 5 years. No increased risk for myocardial infarction or cardiac death was observed. CONCLUSIONS: The addition of acupuncture and self-care education was found to be cost beneficial in patients with advanced angina pectoris. The results invite further testing in a randomized controlled trial.