Randomised controlled trial of two advanced and extended cardiac rehabilitation programmes.

Abstract

OBJECTIVE:

The OPTICARE (OPTImal CArdiac REhabilitation) randomised controlled trial compared two advanced and extended cardiac rehabilitation (CR) programmes to standard CR for patients with acute coronary syndrome (ACS). These programmes were designed to stimulate permanent adoption of a heart-healthy lifestyle. The primary outcome was the SCORE (Systematic COronary Risk Evaluation) 10-year cardiovascular mortality risk function at 18 months follow-up.

METHODS:

In total, 914 patients with ACS (age, 57 years; 81% men) were randomised to: (1) 3 months standard CR (CR-only); (2) standard CR including three additional face-to-face active lifestyle counselling sessions and extended with three group fitness training and general lifestyle counselling sessions in the first 9 months after standard CR (CR+F); or (3) standard CR extended for 9 months with five to six telephone general lifestyle counselling sessions (CR+T).

RESULTS:

In an intention-to-treat analysis, we found no difference in the SCORE risk function at 18 months between CR+F and CR-only (3.30% vs 3.47%; p=0.48), or CR+T and CR-only (3.02% vs 3.47%; p=0.39). In a per-protocol analysis, two of three modifiable SCORE parameters favoured CR+F over CR-only: current smoking (13.4% vs 21.3%; p<0.001) and total cholesterol (3.9 vs 4.3 mmol/L; p<0.001). The smoking rate was also lower in CR+T compared with the CR-only (12.9% vs 21.3%; p<0.05).

CONCLUSIONS:

Extending CR with extra behavioural counselling (group sessions or individual telephone sessions) does not confer additional benefits with respect to SCORE parameters. Patients largely reach target levels for modifiable risk factors with few hospital readmissions already following standard CR.

TRIAL REGISTRATION NUMBER:

ClinicalTrials.gov NCT01395095; results.

• Authors: Madoka Sunamura, Nienke Ter Hoeve, Rita J G van den Berg-Emons, Marcel L Geleijnse, Mirjam Haverkamp, Henk J Stam, Eric Boersma, Ron T van Domburg
• Journal: Heart (British Cardiac Society) (Heart) Vol. 104 Issue 5 Pg. 430-437 (03 2018) ISSN: 1468-201X [Electronic] England
• PMID: 28954826 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 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.

Chemical References

• Anticholesteremic Agents
• Biomarkers
• Cholesterol

Topics

• Acute Coronary Syndrome (diagnosis, mortality, physiopathology, rehabilitation)
• Aged
• Anticholesteremic Agents (therapeutic use)
• Biomarkers (blood)
• Cardiac Rehabilitation (methods)
• Cholesterol (blood)
• Counseling
• Diet, Healthy
• Exercise
• Female
• Healthy Lifestyle
• Humans
• Male
• Middle Aged
• Netherlands
• Recovery of Function
• Risk Factors
• Risk Reduction Behavior
• Smoking (adverse effects)
• Smoking Cessation
• Time Factors
• Treatment Outcome