TY - JOUR
T1 - Expanded cardiac rehabilitation in socially vulnerable patients with myocardial infarction
T2 - a 10-year follow-up study focusing on mortality and non-fatal events
AU - Hald, Kathrine
AU - Nielsen, Kirsten Melgaard
AU - Nielsen, Claus Vinther
AU - Meillier, Lucette Kirsten
AU - Larsen, Finn Breinholt
AU - Christensen, Bo
AU - Larsen, Mogens Lytken
N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2018
Y1 - 2018
N2 - OBJECTIVE: Cardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socially differentiated CR intervention and examine the impact of the intervention on all-cause mortality, cardiovascular mortality, non-fatal recurrent events and major cardiac events (MACE) 10 years after.DESIGN: Prospective cohort study.SETTING: The cardiac ward at a university hospital in Denmark from 2000 to 2004.PARTICIPANTS: 379 patients aged <70 years admitted with first episode myocardial infarction (MI). The patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and their social network. A complete follow-up was achieved.INTERVENTION: A socially differentiated CR intervention. The intervention consisted of standard CR and additionally a longer phase II course, more consultations, telephone follow-up and a better handover to phase III CR in the municipal sector, in general practice and in the patient association.MAIN OUTCOME MEASURES: All-cause mortality, cardiovascular mortality, non-fatal recurrent events and MACE.RESULTS: There was no significant difference in all-cause mortality (OR: 1.29, 95% CI 0.58 to 2,89), cardiovascular mortality (OR: 0.80, 95% CI 0.31 to 2.09), non-fatal recurrent events (OR:1.62, 95% CI 0.67 to 3.92) or MACE (OR: 1.31, 95% CI 0.53 to 2.42) measured at 10-year follow-up when comparing the expanded CR intervention to standard CR.CONCLUSIONS: Despite the significant results of the socially differentiated CR intervention at 1-year follow-up, no long-term effects were seen regarding the main outcome measures at 10-year follow-up. Future research should focus on why it is not possible to lower the mortality and morbidity significantly among socially vulnerable patients admitted with first episode MI.
AB - OBJECTIVE: Cardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socially differentiated CR intervention and examine the impact of the intervention on all-cause mortality, cardiovascular mortality, non-fatal recurrent events and major cardiac events (MACE) 10 years after.DESIGN: Prospective cohort study.SETTING: The cardiac ward at a university hospital in Denmark from 2000 to 2004.PARTICIPANTS: 379 patients aged <70 years admitted with first episode myocardial infarction (MI). The patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and their social network. A complete follow-up was achieved.INTERVENTION: A socially differentiated CR intervention. The intervention consisted of standard CR and additionally a longer phase II course, more consultations, telephone follow-up and a better handover to phase III CR in the municipal sector, in general practice and in the patient association.MAIN OUTCOME MEASURES: All-cause mortality, cardiovascular mortality, non-fatal recurrent events and MACE.RESULTS: There was no significant difference in all-cause mortality (OR: 1.29, 95% CI 0.58 to 2,89), cardiovascular mortality (OR: 0.80, 95% CI 0.31 to 2.09), non-fatal recurrent events (OR:1.62, 95% CI 0.67 to 3.92) or MACE (OR: 1.31, 95% CI 0.53 to 2.42) measured at 10-year follow-up when comparing the expanded CR intervention to standard CR.CONCLUSIONS: Despite the significant results of the socially differentiated CR intervention at 1-year follow-up, no long-term effects were seen regarding the main outcome measures at 10-year follow-up. Future research should focus on why it is not possible to lower the mortality and morbidity significantly among socially vulnerable patients admitted with first episode MI.
KW - Angina pectoris
KW - Cardiac rehabilitation
KW - Educational status
KW - Marital status
KW - Mortality
KW - Myocardial infarction
KW - Single person
KW - Social support
KW - Treatment outcome
KW - Vulnerable populations
UR - http://www.scopus.com/inward/record.url?scp=85052181195&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2017-019307
DO - 10.1136/bmjopen-2017-019307
M3 - Journal article
C2 - 29362268
SN - 2044-6055
VL - 8
JO - BMJ Open
JF - BMJ Open
IS - 1
M1 - e019307
ER -