Abstract
Common concerns with the traditional protocol (TP) for cardiac rehabilitation include
suboptimal program participation, poor facilitation of independent exercise, the use
of costly continuous electrocardiographic (ECG) monitoring, and lack of insurance
reimbursement. To address these concerns, a reduced cost-modified protocol (MP) was
developed to promote independent exercise. Eighty low- to moderate-risk cardiac patients
were randomized to a TP (n = 42) or a MP (n = 38) and were compared over 6 months
on program participation, exercise adherence, cardiovascular outcomes, and program
costs. During month 1, patients followed identical regimens, including 3 ECG-monitored
exercise sessions/week, with encouragement to achieve ≥5 thirty-minute sessions/week.
In week 5, the TP continued with a facility-based regimen including 3 exercise sessions/week
for 6 months and used ECG monitoring the initial 3 months. The MP discontinued ECG
monitoring in week 5 and were gradually weaned to an off-site exercise regimen that
was complemented with educational support meetings and telephone follow-up. Compared
with TP patients, MP patients had higher rates of off-site exercise over 6 months
(p = 0.05), and total exercise (on site + off site) during the final 3 months (p =
0.03). Also, MP patients were less likely to drop out (p = 0.05). Both protocols promoted
comparable improvements in maximal oxygen uptake (p <0.05), blood lipids (p <0.001),
and hemodynamic measurements (p <0.002). The MP cost $738 less/patient than the TP
and required 30% less staff (full-time equivalents). These results suggest that a
reduced cost MP was as effective as an established TP in improving physiologic outcomes
while demonstrating higher rates of exercise adherence and program participation.
Thus, the MP or a similar protocol has applicability to hospitals with large capitated
or managed care populations to provide cost-effective cardiovascular risk reduction
to patients.
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Article Info
Publication History
Published online: August 16, 2004
Footnotes
☆This study was supported in part by Blodgett Memorial Medical Center Research Fund, East Grand Rapids, Michigan; the Kent County Health Department Cardiovascular Mini-Grant, and the Merck Pharmaceutical Educational Grant, Grand Rapids, Michigan. Manuscript received September 19, 1999; revised manuscript received and accepted January 17, 2000.
Identification
Copyright
© 2000 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
