Jolly Kate, Lip Gregory Y H, Sandercock Josie, Greenfield Sheila M, Raftery James P, Mant Jonathan, Taylor Rod, Lane Deirdre, Lee Kaeng Wai, Stevens A J
Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
BMC Cardiovasc Disord. 2003 Sep 10;3:10. doi: 10.1186/1471-2261-3-10.
Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation.
METHODS/DESIGN: A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting.
We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation.
Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity.In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence.
More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation Uptake Maximisation Study (BRUM) study and has implications for the clinical management of these patients. A novel feature of this study is the inclusion of non-English Punjabi speakers.
心肌梗死后的心脏康复可降低后续死亡率，但康复计划的参与率和依从性仍然较低，尤其是在女性、老年人和少数族裔群体中。家庭心脏康复有效性的证据仍然有限。本试验评估家庭心脏康复与医院心脏康复相比的有效性和成本效益。
方法/设计：设计了一项实用的随机对照试验，比较英国四个为多民族市中心人口服务的医院中家庭心脏康复与医院心脏康复的效果。家庭康复计划由护士协助，以《心脏手册》为基础。医院康复计划在门诊环境中提供全面的心脏康复服务。
我们将对650名成年心肌梗死、冠状动脉成形术或冠状动脉搭桥术后低中风险、说英语或旁遮普语且被转诊进行心脏康复的患者进行随机分组。
在6个月、12个月和24个月时测量血清胆固醇、戒烟情况、血压、医院焦虑抑郁量表评分、往返穿梭步行试验行走距离。将使用患者对活动的自我报告来评估对康复计划的依从性。对未参与者和不依从者进行深入访谈，以确定患者的观点以及康复计划的可接受性，并深入了解未参与和不依从的原因，旨在构建一个关于心脏康复参与情况的理论。经济分析将使用资源投入来衡量国民医疗服务体系成本。患者成本将通过定性研究确定，特别是它们如何影响依从性。
对于心肌梗死和血管重建术后患者，家庭心脏康复与医院心脏康复的作用需要更多数据，伯明翰康复最大化研究（BRUM）将提供这些数据，这对这些患者的临床管理具有重要意义。本研究的一个新特点是纳入了说旁遮普语而非英语的患者。
