Developing the evidence base for cardiac rehabilitation: a 30 year & 6 cities journey

Transcription

1 Developing the evidence base for cardiac rehabilitation: a 30 year & 6 cities journey Rod Taylor MSc, PhD Professor of Health Services Research & Director of Exeter Clinical Trials Unit University of Exeter Medical School. Exeter, UK & Adjunct Professor, University of Southern Denmark June 9th 2017, REHPA, Nyborg, Denmark.

2 The treatment itself has no side effects - but the number of statisticians needed to prove its value may cause dizziness and nausea 2

3

4 PhD - Physical Training in Middle Aged Men Examine the physiological effect of a comparatively strenuous program of strenuous program of endurance training in group of middle aged men Assessments at prior to training (T1) and after 15 (T2) and 30 wks (T3) training 53 sedentary males; aged yrs

5 Results

6 JAMA 1988;260:

7 Exercise-Based CR for CHD 36 RCTs in 8440 post MI and revascularisation patients Compared to control, CR reduced risk of all cause death by 19% (Odds Ratio: 0.81, 95% 0.72, 0.91) Improvements in lipids, and BP Limited data on HRQoL Quality of reporting poor

8 Title Cochrane CR Portfolio Version Publication status Exercise based rehabilitation for. CHD [9811] Stable angina [1612] Heart failure [0025] Atrial fibrillation [1401] Post valve surgery [1301] Implantable cardiac defibrillators [1409] Cardiac transplantation [1506] v3 v1 v3 v1 v1 v1 v1 Jan 2016 Ongoing (Q2 2017) Ongoing (Q4 2017) Feb 2017 Mar 2016 Ongoing (Q3 2017) Apr 2017 Psychological interventions for CHD [0010] v3 Mar 2017 Educational interventions for CHD [1005] v (in press) Home vs centre based interventions [0802] v (in press) Interventions to increase uptake & adherence [0422] v3 Ongoing (Q4 2017)

9

10

11

12 Cardiac Rehabilitation: The evidence from the Cochrane Reviews Rod Taylor, MSc PhD Dept of Public Health & Epidemiology, University of Birmingham Hjerterehbilitering I Denmark, Copenhagen, 28 th October 2004

13

14 NICE CG 108 (2011) Evidence synthesis Research gap identification Clinical Trial Priority setting

15 28 th July 2014!

16

17

18 REACH HF Funded by NIHR Programme Grant, Programme consists of linked work packages to: develop, a home based, self-help CR programme ('the HF Manual') for people with HF and their caregivers pilot trial assess feasibility of definitive trial of the HF Manual in HFPEF multi-centre RCT to assess effectiveness and cost effectiveness of HF Manual vs. usual care in people with HFREF and their caregivers evidence synthesis/modelling of the effectiveness and cost effectiveness of the HF Manual vs. centre-based CR in HFREF and HFPEF

19 REACH-HF contributors Truro Dr H Dalal Dr Jenny Wingham Dr Robin Van Lingen Kevin Paul (PPI) Exeter Professor Charles Abraham Professor Nicky Britten Dr Colin Greaves Dr Colin Green Professor Rod Taylor Dundee Edinburgh Birmingham Professor Kate Jolly Dr Russell Davis York Professor Patrick Doherty York Gwent Dr Jackie Austin Edinburgh Heart Manual office Dundee Prof Chim Lang Dr Karen Smith Birmingham Gwent Exeter Truro

20 REACH HF PROGRAMME No. of participants Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Development of home-based intervention for HFrEF & HFPEF Development of caregiver resource REACH HF intervention model Feasibility study of HF Manual versus usual care in HFrEF Full multicenter RCT of HF Manual versus usual care with parallel process and economic evaluations in HFrEF Pilot RCT of HF Manual versus usual care in HFpEF 0 Target versus actual number of participants randomised for WP2 Pilot trial Updated Cochrane review of RCTs of CR for HF Month Decision analytic economic modelling Target randomised Actual randomised

21 The researches of many commentators have already thrown much darkness on this subject, and it is probable that if they continue, we shall soon know nothing at all about it. Mark Twain

22 And the next (last) 5 yrs Danish Heart Foundation Review of reviews [Sept!] UK MRC Global Challenges Implementing cost-effective CR in Bangladesh & Malaysia [Q1 2018] REACH-HFpEF Full trial application to NIHR HTA [Q3 2017] REACH-AF UK NIHR Programme Grant Application [Q3 2017]

23