A systematic review of economic evaluations of cardiac rehabilitation

Academic Programmes Division, Singapore Institute of Technology, 25 North Bridge Road, Singapore, Singapore. .
BMC Health Services Research (Impact Factor: 1.71). 08/2012; 12(1):243. DOI: 10.1186/1472-6963-12-243
Source: PubMed


Cardiac rehabilitation (CR), a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI), revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF). This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR.
Electronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL) were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond's checklist.
A total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1) supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2) home-based CR was no different from centre-based CR; (3) no difference existed between inpatient and outpatient CR; and (4) home-based programs were generally cost-saving compared to no CR.
Overall, all the studies supported the implementation of CR for MI and HF. However, comparison across studies highlighted wide variability of CR program design and delivery. Policy makers need to exercise caution when generalizing these findings to the Singapore context.

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Available from: Wai Pong Alan Wong, Jun 21, 2015
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    • "Patients who adhere to CPMR programs experience improved quality of life, hemodynamic stabilization, metabolic changes, and improved vascular and psychological states, which are associated with better control of risk factors and improvement in lifestyle [15] [16]. Studies have already demonstrated the cost-effectiveness of CPMR, which became necessary for the rehabilitation of patients affected by these diseases [8] [9] [12]. "
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    ABSTRACT: An influence diagram (ID) is a method of graphical representation of uncertain knowledge, which can be employed to support decisions in health care using probabilistic reasoning. We aimed to describe the development of an ID to support the decision-making process in phase II at Cardiopulmonary and Metabolic Rehabilitation Program (CPMR). The development of the ID was carried out through the identification of relevant variables and their possible values, as well as the identification of details of each variable, in order to find a network structure that appropriately connects the nodes that represent the variables, with arcs linking acyclic graphs, and to build the graph using specialized knowledge and the conditional probability table for each node in the graph. In spite of the complexity of the interactions, the model obtained with the ID seems to contribute in the decision-making process in phase II CPMR, providing a second opinion to the health pratictioner and helping in diagnostic, therapeutic and decision-making processes, since it is useful in situations with non-linear modeling or with absent or uncertain information.
    15th World Congress on Health and Biomedical Informatics, São Paulo; 08/2015
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    • "The primary goals of OP-CR include reduction of modifiable risk factors as well as increasing functional capacity and quality of life. Outpatient CR is recommended by the American Heart Association (AHA) and the American College of Cardiology Guidelines for a number of diagnoses including myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass surgery (CABG) [5] [6] [7] [8] [9] [10]. In 2014, OP-CR services were approved for patients with systolic HF by the Center for Medicare and Medicaid Services [11]. "
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    ABSTRACT: Background: Outpatient cardiac rehabilitation (OP-CR) is a highly beneficial program but vastly under utilized. Methods: The efficacy of a text-messaging program was analyzed to determine if implementation could improve number of OP-CR sessions completed. All patients enrolled in OP-CR from July 2011 through December 2012 were invited to join a text-messaging program on their first visit. The program required that the patient possesses a cell phone with texting capabilities. Participants received three to five text-messages per week offering heart-healthy tips and requests for body weight, minutes of exercise, blood pressure, and medication adherence. Patients enrolled (n. =. 52) in the texting program (Tx) were compared with those who were not (n. =. 185) (NTx) in several clinical indices and were compared using matched pairs (same subjects), comparison of means and frequencies, chi-square statistics, t-tests, and the Wilcoxon Rank Sum test. Results: Significantly more patients in the Tx group completed the OP-CR program (61.5% versus 50%, p=. 0.01). For those completing OP-CR, subjects in the Tx group completed significantly more sessions (31.4) than the NTx group (25.3) (. p=. 0.01). Additionally, significantly more in the Tx group were younger than those in the Ntx group. Conclusions: Patients enrolled in OP-CR who participated in a text-messaging program were younger, attended significantly more sessions and were significantly more likely to complete the program.
    04/2015; 61. DOI:10.1016/j.ijcha.2015.04.002
    • "Adapted from Oldridge[18] Abbreviations RCTs randomised clinical trials; MI myocardial infarction; CHD coronary heart disease. a systematic review have confirmed the cost-effectiveness of CR in patients with CHD [18] [34]. A meta-analysis of 47 randomised controlled trials demonstrated that CR significantly reduced re-hospitalisation by 31% (OR = 0.69; 95% CI 0.51–0.93) "
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    ABSTRACT: Cardiovascular disease is a leading cause of morbidity worldwide. Cardiac rehabilitation (CR) is a comprehensive secondary prevention approach, with established benefits in reducing morbidity in high-income countries (HICs). The objectives of this review were to summarise what is known about the benefits of CR, including consideration of cost-effectiveness, in addition to rates of CR participation and adherence in high-, as well as low- and middle-income countries (LMICs). A literature search of Medline, Excerpta Medica Database (EMBASE), and Google Scholar was conducted for published articles from database inception to October 2013. The search was first directed to identify meta-analyses and reviews reporting on the benefits of CR. Then, the search was focussed to identify articles reporting CR participation and dropout rates. Full-text versions of relevant abstracts were summarised qualitatively. Based on meta-analysis, CR significantly reduced all-cause mortality by 13%-26%, cardiac mortality by 20%-36%, myocardial re-infarction by 25%-47%, and risk factors. CR is cost-effective in HICs. In LMICs, CR is demonstrated to reduce risk factors, with no studies on mortality or cost-effectiveness. Based on available data, CR participation rates are <50% in the majority of countries, with documented dropout rates up to 56% and 82% in high- and middle-income countries, respectively. CR is a beneficial intervention for heart patients in high and LMICs, but is underutilised with low participation and adherence rates worldwide. While more research is needed in LMICs, strategies shown to increase participation and program adherence should be implemented. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
    Heart, Lung and Circulation 11/2014; 24(5). DOI:10.1016/j.hlc.2014.11.013 · 1.44 Impact Factor
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