ESC CONGRESS Munich, Germany, August. Compliance to a Cardiac Rehabilitation Program: what are the benefits and impact on prognosis?

Transcription

1 ESC CONGRESS 2012 Munich, Germany, August Compliance to a Cardiac Rehabilitation Program: what are the benefits and impact on prognosis? Inês Rangel (1), Afonso Rocha (2), Carla de Sousa, (1) Alexandra Sousa (1), Ana Sofia Correia (1), Mariana Paiva (1), Filipa Melão (1), Vítor Araújo (1), Fernando Parada-Pereira (2), Maria Júlia Maciel (1) (1) Cardiology Department São João Hospitalar Center (2) Physical Medicine and Rehabilitation Department São João Hospitalar Center Oporto, Portugal inesrang@gmail.com

2 ESC CONGRESS 2012 Munich, Germany, August No conflicts of interest

3 Introduction Cardiac rehabilitation programs (CRP) have consistently demonstrated the ability to improve cardiac risk factors control. In post-acute coronary syndrome patients (ACS), CRP are associated with reductions in total and cardiovascular (CV) mortality, as well as reductions in reinfarction. COMPLIANCE Heran BS, Chen JMH, Ebrahim S et al. Cochrane Database of Systematic Reviews 2011; Issue 7 Lawler PR, Filion KB, Eisenberg MJ. American heart journal 2011;162:

4 Introduction Cardiac rehabilitation programs (CRP) have consistently demonstrated the ability to improve cardiac risk factors control. In post-acute coronary syndrome patients (ACS), CRP are associated with reductions in total and cardiovascular (CV) mortality, as well as reductions in reinfarction. Exercise-based Cardiac Rehabilitation Program metabolism (improves glycemic and lipid profile) functional capacity body weight blood pressure Improvement: perceived quality of life psychological status Heran BS, Chen JMH, Ebrahim S et al. Cochrane Database of Systematic Reviews 2011; Issue 7 Lawler PR, Filion KB, Eisenberg MJ. American heart journal 2011;162:

5 Objective: To assess the clinical benefits and prognostic impact of compliance with a CRP, in a coronary heart disease population. Methods: Cardiac Rehabilitation Program: Exercise-based cardiac reconditioning sessions: bi-weekly sessions, min (30-40 min of aerobic training and min of muscle strengthening), total of sessions (2-3 months), intensity adjusted to 50-70% of HR reserve (initial stress test) and to a perceived exertion on the Borg scale of

6 Objective: To assess the clinical benefits and prognostic impact of compliance with a CRP, in a coronary heart disease population. Methods: Cardiac Rehabilitation Program: Nutrition: dietary habits; Psychiatry: smoking cessation; Psychology: psychoeducational strategy, stress management techniques; Cardiology: follow-up (FU) appointments before and after CRP, at 6 and 12 months after ACS.

7 Objective: To assess the clinical benefits and prognostic impact of compliance with a CRP, in a coronary heart disease population. Methods: Retrospective study including 241 patients referred to a CRP after ACS, between September 2008 and November Information on socio-demographic, clinical and functional data was collected pre and post CRP. Medical records reviews and telephonic interviews with patients with 12 months of FU after the index event were used to assess: overall mortality and nonfatal cardiovascular events (hospitalization for CV causes, need for coronary revascularization) Composite Endpoint; cardioprotective drug therapy, functional capacity and CV risk factors control.

8 Objective: To assess the clinical benefits and prognostic impact of compliance with a CRP, in a coronary heart disease population. Methods: Non compliant patients: Those eligible to CRP, who were assessed through an initial cardiac rehabilitation consultation and who have abandoned the CRP (< 70% of the total prescribed exercise sessions).

9 Results Table I Baseline clinical and functional features Compliance to CRP Total n=241 Yes n=217 No n=24 Female, n (%) 26 (11) 20 (9) 6 (25) Male, n (%) 215 (89) 197 (91) 18 (75) p Of the 241 patients enrolled, 24 (10%) discontinued the program. Age, mean (sd) 54 (10) 54 (10) 52 (10) NS Fam Hx CD, n (%) 68 (28) 63 (29) 5 (21) NS Hypertension, n (%) 88 (37) 76 (35) 12 (50) NS Dyslipidemia, n (%) 124 (51) 9 (38) 115 (53) NS Women and obese patients were less likely to adhere to CRP (p <0.05). Tabagism, n (%) 185 (77) 165 (76) 20 (83) NS Diabetes mellitus, n (%) 48 (20) 41 (19) 7 (29) NS BMI 30, n (%) 55 (23) 45 (21) 10 (41) LVEF < 50%, n (%) 66 (27) 61 (29) 5 (22) NS NS non significant; * Statistical significance for p value <0.05 Fam Hx CD Familiar history of coronary disease; BMI Body mass index; LVEF- Left ventricle ejection fraction.

10 Results The FU was possible in 227 (94%) patients, with mean FU of 25 ± 7 months. Table II Clinic, functional and metabolic status, 12 months post CV event. Compliant Non Compliant n=204 n= 23 p Smoking cessation (%) 70% 18% Physical activity** (%) 82% 25% Difference of values obtained at the moment and after 12 months of the CV event. Compliant p Non Compliant p In the FU evaluation, CRP compliant patients achieved better control of CV risk: > Rate of smoking cessation > Physical activity > Functional capacity > Better lipid profile EST f-i (METS), mean (sd) 0.8 (1.6) < (0.9) NS LDL-C (mg/dl), mean (sd) (39.6) < (37.1) NS HDL-C (mg/dl), mean (sd) 3.2 (8.7) < (6.4) NS Tg (mg/dl) mean (sd) (102.7) < (58.6) NS NS non significant; * Statistical significance for p value <0.05 ** 600 METS / minute / week; (SF 36); METS- Metabolic equivalents; ESTf-i METS difference between final and inicial exercise stress testing. Lipid profile : LDL-C e HDL-C: colesterol LDL e HDL; Tg: triglycerides

11 Results The FU was possible in 227 (94%) patients, with mean FU of 25 ± 7 months. Table II Clinic, functional and metabolic status, 12 months post CV event. Compliant n=204 Non Compliant n= 23 p Smoking cessation (%) 70% 18% Physical activity** (%) 82% 25% Difference of values obtained at the moment and after 12 months of the CV event. Compliant p Non Compliant p EST f-i (METS), mean (sd) 0.8 (1.6) < (0.9) NS LDL-C (mg/dl), mean (sd) (39.6) < (37.1) NS HDL-C (mg/dl), mean (sd) 3.2 (8.7) < (6.4) NS Tg (mg/dl) mean (sd) (102.7) < (58.6) NS NS non significant; * Statistical significance for p value <0.05 ** 600 METS / minute / week; (SF 36); METS- Metabolic equivalents; ESTf-i METS difference between final and inicial exercise stress testing. Lipid profile : LDL-C e HDL-C: colesterol LDL e HDL; Tg: triglycerides Table III Pharmacologic therapy at FU Non Compliant Total Compliant p n=204 n= 23 Anti-platelet (%) NS Statins (%) NS Beta Blocker (%) NS ACEI/ ARB (%) NS NS non significant; * Statistical significance for p value <0.05

12 Results The FU was possible in 227 (94%) patients, with mean FU of 25 ± 7 months. Table IV Composite endpoint at FU Total Compliant Non compliant p Figure 1 Cox regression analysis HR: 2.2 (95% CI: 0.7 to 6.4). 10% 9% 17% 0,182 Composite endpoint: Overall mortality and nonfatal cardiovascular events 91% small numbers of non-adherent patients short FU 83%

13 Conclusions CRP compliant patients have a significant higher improvement in cardiovascular risk profile, functional capacity and tend to suffer less cardiovascular events than non compliant patients. Specific strategies are needed, in order to prevent drop-out and maximize the benefit of CRP.

14 Conclusions CRP compliant patients have a significant higher improvement in cardiovascular risk profile, functional capacity and tend to suffer less cardiovascular events than non compliant patients. Specific strategies are needed, in order to prevent drop-out and maximize the benefit of CRP. Patients Benefits clarification Psycho-educational support Individual patients needs Health workers Education Health System After work sessions Reimbursement