Abstract
Objective
To compare traditional (1-month supervised) vs hybrid cardiac rehabilitation (CR;
usual care) with an additional 3 months offered remotely based on the continuous care
model (intervention) in patients who have undergone coronary artery bypass graft (CABG).
Design
Randomized controlled trial, with blinded outcome assessment.
Setting
A major heart center in a middle-income country.
Participants
Of 107 eligible patients who were referred to CR during the period of study, 82.2%
(N=88) were enrolled (target sample size). Participants were randomly assigned 1:1
(concealed; 44 per parallel arm). There was 92.0% retention.
Interventions
After CR, participants were given a mobile application and communicated biweekly with
the nurse from months 1-4 to control risk factors.
Main Outcome Measures
Quality of life (QOL, Short Form-36, primary outcome); functional capacity (treadmill
test); and the Depression, Anxiety and Stress Scale were evaluated pre-CR, after 1
month, and 3 months after CR (end of intervention), as well as rehospitalization.
Results
The analysis of variance interaction effects for the physical and mental component
summary scores of QOL were <.001, favoring intervention (per protocol); there were
also significant increases from pre-CR to 1 month, and from 1 month to the final assessment
in the intervention arm (P<.001), with change in the control arm only to 1 month. The effect sizes were 0.115
and 0.248, respectively. Similarly, the interaction effect for functional capacity
was significant (P<.001), with a clinically significant 1.5 metabolic equivalent of task increase in
the intervention arm. There were trends for group effects for the psychosocial indicators,
with paired t tests revealing significant increases in each at both assessment points in the intervention
arm. At 4 months, there were 4 (10.3%) rehospitalizations in the control arm and none
in intervention (P=.049). Intended theoretical mechanisms were also affected by the intervention.
Conclusions
Extending CR in this accessible manner, rendering it more comprehensive, was effective
in improving outcomes.
Keywords
List of abbreviations:
ANOVA (analysis of variance), CABG (coronary artery bypass graft), CCM (continuous care model), CR (cardiac rehabilitation), CVD (cardiovascular disease), LMIC (low‐ and middle‐income countries), MCS (mental component summary), PCS (physical component summary), QOL (quality of life)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 23, 2021
Accepted:
April 23,
2021
Received in revised form:
March 23,
2021
Received:
February 1,
2021
Footnotes
Clinical Trial Registration No.: IRCT20130211012439N3.
Disclosures: none.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of The American Congress of Rehabilitation Medicine.
