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Pedersen CG, Nielsen CV, Lynggaard V, Zwisler AD, Maribo T. Cardiac rehabilitation: pedagogical education strategies have positive effect on long-term patient-reported outcomes. Health Educ Res 2023; 38:597-609. [PMID: 37534750 DOI: 10.1093/her/cyad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/07/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023]
Abstract
This study examined whether patients attending cardiac rehabilitation (CR) based on the pedagogical strategy learning and coping (LC) led to improved health-related quality of life (HRQL), reduced symptoms of anxiety and depression and improved self-management 6 and 12 months after the completion of CR compared with patients attending CR based on the pedagogical strategy 'Empowerment, Motivation and Medical Adherence' (EMMA). A pragmatic cluster-controlled trial of two pedagogical strategies, LC and EMMA, including 10 primary health care settings and 555 patients diagnosed with ischaemic heart disease and referred to CR between August 2018 and July 2019 was conducted. In total, 312 patients replied to the questionnaires collected at baseline, 12 weeks, 6 months and 12 months after completing CR. Linear regression analyses adjusted for potential confounder variables and cluster effects were performed. We found clinically relevant and statistically significant improvements in HRQL, anxiety, depression and self-management after completing CR. The improvements were sustained at 6 and 12 months after the completion of CR. We found no differences between the two evidence-based patient education strategies. In conclusion, this study supports the use of evidence-based patient education strategies, but there is no evidence to suggest that one pedagogical strategy is superior to the other.
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Affiliation(s)
- C G Pedersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Blvd. 11, Aarhus 8200, Denmark
- Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
| | - C V Nielsen
- Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
- DEFACTUM, Central Denmark Region, Evald Krogs Gade 11, Aarhus 8000, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Hospitalsparken 15, Gødstrup, Herning 7400, Denmark
| | - V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, Gødstrup, Herning 7400, Denmark
| | - A D Zwisler
- REHPA The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, Nyborg 5800, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløws Vej 19, Odense 5000, Denmark
| | - T Maribo
- Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
- DEFACTUM, Central Denmark Region, Evald Krogs Gade 11, Aarhus 8000, Denmark
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Kjesbu I, Prescott E, Rasmusen HK, Osler M, Larsen ML, Gustafsson I, Zwisler AD, Sibilitz KL. Cardiac rehabilitation do not diminish the socioeconomic and ethnical disparity in patients with coronary heart disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Cardiac patients with low socioeconomic status and non-western ethnic background have worse outcomes. The aim of this nationwide study was to determine whether the immediate effect of CR differs between groups defined by socioeconomic status and ethnic background, and whether disparity in the prognosis of cardiac patients is diminished by CR participation.
Methods
We included all patients in Denmark with myocardial infarction and/or coronary revascularization from August 2015 until March 2018. Level of education, as a marker for socioeconomic status, was divided into four groups, and ethnicity into Danish, non-Western and Western. Participation in CR was identified through the Danish Cardiac Rehabilitation Database (DHRD) and the Danish National Patient Register. Primary outcome was achievement of CR quality indicators, including risk factor control and medication, from DHRD, and secondary outcome a composite endpoint of cardiovascular disease hospitalization and all-cause mortality (MACE).
Results
We identified 34,511 patients of whom 19,383 had participated in CR and 9,882 provided information on CR data from DHRD. Higher education was associated with greater improvement in VO2peak and non-western patients were less likely to be screened for depression or receive dietary consulting. No other significant disparity in CR quality indicators, was found across education and ethnicity. There was a strong socioeconomic gradient in MACE irrespective of CR participation, medication and risk factor control (adjusted HR 0.71 (0.58–0.86) for high versus low education). Similarly, non-western origin was associated with higher risk of MACE (adjusted HR 1.2 (1.1–1.4).
Conclusion
We found strong socioeconomic and ethnic disparity in prognosis of CHD patients which were unaffected by CR participation. The results indicate that CR, conventional risk factor control and medical treatment have limited impact on these disparities.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Figure 1Figure 2
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Affiliation(s)
- I Kjesbu
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - H K Rasmusen
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - M Osler
- University of Copenhagen, Section of Epidemiology, Department of Public Health, Copenhagen, Denmark
| | - M L Larsen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - I Gustafsson
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - A D Zwisler
- University of Southern Denmark, National Centre of Rehabilitation and Palliation, University Hospital Odense, Odense, Denmark
| | - K L Sibilitz
- Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
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Thygesen LC, Zinckernagel L, Dalal H, Egstrup K, Glumer C, Gronbaek M, Holmberg T, Kober L, La Cour K, Nakano A, Nielsen CV, Sibilitz KL, Tolstrup JS, Zwisler AD, Taylor RS. Cardiac rehabilitation for patients with heart failure: a national Danish register-based study of predictors of referral and outcomes. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
Background
Heart failure (HF) places a large burden on patients and society as a major cause of morbidity, mortality and healthcare costs. Participation in exercise-based cardiac rehabilitation (CR) in people with HF is a clinically and cost-effective strategy and recommended in international clinical guidelines.
Purpose
The aims of this study were to: (1) examine the temporal trends and predictors of national CR referral, and (2) compare the risk of hospital readmission and mortality in those referred for CR compared to no referral.
Methods
All patients in Denmark with incident HF were identified by the Danish Heart Failure Register in the period 2010 to 2018 (n = 33,257) and CR referral assessed within 120 days of hospital admission. Multivariable logistic regression models were used to evaluate the association between CR referral and predictors and to compare risk of hospital readmission and mortality until 1 year between referred and not referred patients.
Results
Overall, 45.0% of HF patients were referred to exercise-based CR, increasing from 31.7% in 2010 to 52.2% in 2018. Factors independently associated with higher CR referral were: NYHA functional class II, LVEF <50%, diagnosis of myocardial infarction and use of ACE inhibitor. Male gender, older age, region, unemployment, retirement, living alone, non-Danish ethnic origin, lower educational level, NYHA class IV, treatment for hypertension, existing chronic obstructive lung disease and stroke were associated with lower CR referral. CR referral was associated with lower risk of readmission (adjusted odds ratio: 0.90;95%CI: 0.85-0.95), HF-specific mortality (0.61; 0.39-0.95) and all-cause mortality (0.61; 0.55-0.69) as compared to no referral.
Conclusions
Although CR referral has increased over time, only some 1 in 2 diagnosed HF patients in Denmark are referred to exercise-based CR. CR referral is associated with lower risk in readmissions and mortality. Strategies to promote CR referral including healthcare professional education on the benefits of CR and alternative methods of CR delivery are urgently needed to improve access to CR, especially for high-risk groups.
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Affiliation(s)
- LC Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - H Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom of Great Britain & Northern Ireland
| | - K Egstrup
- Department of Cardiovascular Research, Odense University Hospital, Svendborg, Denmark
| | - C Glumer
- Center for diabetes in the city of Copenhagen, Copenhagen, Denmark
| | - M Gronbaek
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - T Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - K La Cour
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Nakano
- The Danish Clinical Registries (RKKP), Aarhus, Denmark
| | - CV Nielsen
- DEFACTUM, Regional Hospital West Jutland, Central Denmark Region, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - KL Sibilitz
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - JS Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - AD Zwisler
- REHPA The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - RS Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom of Great Britain & Northern Ireland
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Lynggaard V, Zwisler AD, Taylor RS, May O, Mortensen J, Nielsen CV. Short- and long-term effects of the patient education strategy-learning and coping-in cardiac rehabilitation: a randomized controlled trial (LC-REHAB). Health Educ Res 2021; 36:41-60. [PMID: 33755118 DOI: 10.1093/her/cyaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
The objectives were to assess the short- and long-term effect of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on health-related quality of life, patient education impact, cardiac risk factors and lifestyle. In total, 825 patients hospitalized with ischaemic heart disease or heart failure were randomized to either LC-CR or standard CR at three Danish hospitals. Teaching approach in LC-CR was situational, inductive and reflective, with experienced patients as co-educators and supplemental interviews. Teaching approach in standard CR was structured and deductive. Outcomes were assessed immediately after CR, and after 3 months (short term), and after 3 years (long term). Between-arm differences in favour of LC-CR were SF-12 'role emotional' (3.7, 95% CI: 0.6-6.8) and MDI depression score (0.9, 0.1-1.8) immediately after CR, exercise capacity (4 W, 1-9) at 3 months and SF-12 'role physical' (4.6, 0.1-9.0) (long term). Between-arm differences in favour of controls were waist circumference (-1.7 cm, -2.3 to -1.0) immediately after CR and HeiQ domain 'Constructive attitudes and approaches' (0.11, 0.04-0.18), triglycerides (-0.12 mmol/l, -0.21 to -0.02), systolic blood pressure (-3.12 mmHg, -5.66 to -0.58) at 3 months. Adding LC strategies to CR provides inconsistent short-term results but improves 'role physical' long term.
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Affiliation(s)
- V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital (Formerly known as Regional Hospital West Jutland), 61 Gammel Landevej, 7400 Herning, Denmark
| | - A D Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
| | - R S Taylor
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
- MRC/CSO Social and Public Health Sciences Unit, Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - O May
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - J Mortensen
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Lynggaard V, Zwisler AD, Taylor RS, May O, Nielsen CV. Effects of the patient education strategy 'Learning and Coping' in cardiac rehabilitation on readmissions and mortality: a randomized controlled trial (LC-REHAB). Health Educ Res 2020; 35:cyz034. [PMID: 31999315 DOI: 10.1093/her/cyz034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
We assessed the effects of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on mortality and readmissions by exploring results from the LC-REHAB trial. In all, 825 patients with ischaemic heart disease or heart failure were randomized to the intervention arm (LC-CR) or the control arm (standard CR) at three hospitals in Denmark. LC-CR was situational and inductive, with experienced patients as co-educators supplemented with two individual interviews. Group-based training and education hours were the same in both arms. Outcomes were time to death or readmission, length of stay and absolute number of deaths or readmissions. No between-arm differences were found in time to death, first readmission, or length of stay. Within 30 days after completion of CR, the absolute number of all-cause readmissions was 117 in the LC arm and 146 in the control arm, adjusted odds ratio 78 (95% CI: 0.61-1.01), P = 0.06. This trend diminished over time. Adding LC strategies to standard CR showed a short term but no significant long-term effect on mortality or readmissions. However, the study was not powered to detect differences in mortality and morbidity. Thus, a risk of overseeing a true effect was present.
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Affiliation(s)
- V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, 61 Gammel Landevej, 7400 Herning, Denmark
| | - A D Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and Institute of Clinical Medicine, University of Southern Denmark, 17 Vestergade, 5800 Nyborg, Denmark
| | - R S Taylor
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and Institute of Clinical Medicine, University of Southern Denmark, 17 Vestergade, 5800 Nyborg, Denmark
- Institute of Health Research, University of Exeter Medical School, St. Luke's Campus, Heavitree Road, EX1 2LU Exeter, UK
| | - O May
- Department of Cardiology, Regional Hospital West Jutland, 61 Gammel Landevej, Herning 7400, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, 2 Bartholins Allé, 8000 Aarhus C, Denmark
- MarselisborgCentret, DEFACTUM, Central Denmark Region, 11 P.P. Ørums Gade, 8000 Aarhus C, Denmark
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Von Kappelgaard L, Davidsen M, Zwisler AD, Juel K, Gislason G. P6305Socioeconomic gradient in the incidence of aortic stenosis - a nationwide study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - M Davidsen
- National Institute of Public Health, Copenhagen, Denmark
| | - A D Zwisler
- National Institute of Public Health, Copenhagen, Denmark
| | - K Juel
- National Institute of Public Health, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Copenhagen, Denmark
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7
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Frederiksen H, Zwisler A, Johnsen S, Öztürk B, Lindhardt T, Norredam M. 1.4-O5Large differences in uptake of secondary prevention after acute coronary syndrome among migrants compared to Danish-born. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Frederiksen
- Research Center for Migration, Ethnicity and Health (MESU), University of Copenhagen, Denmark
- Department of Internal Medicine, Copenhagen University Hospital, Denmark
| | - A Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
| | - S Johnsen
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - B Öztürk
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - T Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital, Denmark
| | - M Norredam
- Research Center for Migration, Ethnicity and Health (MESU), University of Copenhagen, Denmark
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Frederiksen H, Zwisler A, Johnsen S, Öztürk B, Lindhardt T, Norredam M. 1.4-O6Patient education is associated with medication persistence after acute coronary syndrome among both migrants and local-born in Denmark. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Frederiksen
- Research Center for Migration, Ethnicity and Health (MESU), University of Copenhagen, Denmark
| | - A Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
| | - S Johnsen
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - B Öztürk
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - T Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital, Denmark
| | - M Norredam
- Research Center for Migration, Ethnicity and Health (MESU), University of Copenhagen, Denmark
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Zinckernagel L, Ersbøll AK, Holmberg T, Pedersen SS, Timm H, Zwisler AD. Prevalence and predictors of heart patients’ perceived psychosocial support by the health care system. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - AK Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - T Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - SS Pedersen
- Department of Psychology, University of Southern Denmark; Department of Cardiology, Odense Universi, Odense, Denmark
| | - H Timm
- The Danish Knowledge Center for Rehabilitation and Palliative care, Department of oncology, Universi, Nyborg, Denmark
| | - AD Zwisler
- The Danish Knowledge Center for Rehabilitation and Palliative care, Department of oncology, Universi, Nyborg, Denmark
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Frederiksen HW, Zwisler AD, Johnsen SP, Ozturk B, Lindhardt T, Norredam M. Uptake of secondary prevention following acute coronary syndrome among migrants and Danish born. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- HW Frederiksen
- University of Copenhagen and Copenhagen University Hospital, Herlev, Copenhagen, Denmark
| | - AD Zwisler
- University of Copenhagen and Copenhagen University Hospital, Herlev, Nyborg, Denmark
| | - SP Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - B Ozturk
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - T Lindhardt
- University of Copenhagen and Copenhagen University Hospital, Herlev, Nyborg, Denmark
| | - M Norredam
- University of Copenhagen and Copenhagen University Hospital, Herlev, Copenhagen, Denmark
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Lund K, Sibilitz KL, Berg SK, Thygesen LC, Taylor RS, Zwisler AD. Physical activity increases survival after heart valve surgery. Heart 2016; 102:1388-95. [DOI: 10.1136/heartjnl-2015-308827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/16/2016] [Indexed: 11/04/2022] Open
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Frederiksen HW, Norredam M, Zwisler AD. Access to cardiac rehabilitation for non – native speaking patients. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hansen TB, Zwisler AD, Berg SK, Sibilitz KL, Thygesen LC, Doherty P, Søgaard R. Exercise-based cardiac rehabilitation after heart valve surgery: cost analysis of healthcare use and sick leave. Open Heart 2015; 2:e000288. [PMID: 26301099 PMCID: PMC4538388 DOI: 10.1136/openhrt-2015-000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 01/05/2023] Open
Abstract
Background Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR on the costs of healthcare use and sick leave among heart valve surgery patients over 12 months post surgery. Methods We conducted a nationwide survey on the CR participation of all patients having undergone valve surgery between 1 January 2011 and 30 June 2011 (n=667). Among the responders (n=500, 75%), the resource use categories of primary and secondary healthcare, prescription medication and sick leave were analysed for CR participants (n=277) and non-participants (n=223) over 12 months. A difference-in-difference analysis was undertaken. All estimates were presented as the means per patient (95% CI) based on non-parametric bootstrapping of SEs. Results Total costs during the 12 months following surgery were €16 065 per patient (95% CI 13 730 to 18 399) in the CR group and €15 182 (12 695 to 17 670) in the non-CR group. CR led to 5.6 (2.9 to 8.3, p<0.01) more outpatient visits per patient. No statistically significant differences in other cost categories or total costs €1330 (−4427 to 7086, p=0.65) were found between the groups. Conclusions CR, as provided in Denmark, can be considered cost neutral. CR is associated with more outpatient visits, but CR participation potentially offsets more expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis.
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Affiliation(s)
- T B Hansen
- Department of Cardiology , Roskilde Hospital , Roskilde , Denmark ; Centre for Applied Health Services Research, University of Southern Denmark , Odense , Denmark ; Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - A D Zwisler
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark . ; National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark ; National Centre of Rehabilitation and Palliation, University of Southern Denmark and University Hospital of Odense , Odense , Denmark
| | - S K Berg
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - K L Sibilitz
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark
| | - P Doherty
- Department of Health Sciences , University of York , York , UK
| | - R Søgaard
- Department of Public Health , Aarhus University , Aarhus , Denmark ; Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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Berg S, Zwisler A, Koch M, Svendsen J, Christensen A, Pedersen P, Thygesen L. Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes: Findings from the COPE-ICD randomized controlled trial. J Rehabil Med 2015; 47:267-72. [DOI: 10.2340/16501977-1920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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