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Patient mortality in the 12 years following enrolment into a pre-surgical cardiac rehabilitation programme [with consumer summary] |
Rideout A, Lindsay G, Godwin J |
Clinical Rehabilitation 2012 Jul;26(7):642-647 |
clinical trial |
3/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
OBJECTIVE: This study examined whether involvement in a pre-surgical cardiac rehabilitation programme conferred a long-term survival benefit. DESIGN: Patients randomly allocated to a pre-surgical cardiac rehabilitation programme intervention or a control group were tracked through national databases at a point approximately 12 years later, and all causes of mortality were identified from death records. Kaplan-Meier survival analyses based on involvement in a cardiac rehabilitation programme and known pre-surgical risk factors were carried out. SETTING: Two health boards in the west of Scotland, referring to a single cardiothoracic tertiary centre. SUBJECTS: Patients admitted to the waiting list for coronary artery bypass surgery. INTERVENTIONS: Patients were randomly allocated to a control group ('usual' care) or an intervention group (nurse-led cardiac rehabilitation) in the pre-operative phase. They were followed up at 12 years post surgery. MAIN MEASURES: The only outcome measure used for analysis was survival. Measures of anxiety and depression, and physiological and lifestyle risk factors were included as independent variables in analysis of death. RESULTS: The initial study included 110 patients -- none were lost to follow-up. Relative risk of death associated with inclusion in the cardiac rehabilitation programme was 0.814; risk of death increased with increasing pre-surgical depression (RR 1.07) and anxiety (RR 1.09). CONCLUSIONS: Undertaking pre-surgical cardiac rehabilitation confers a long-term survival advantage over patients not offered this service. Increased anxiety and depression in the pre-surgical phase are additional risk factors for increased mortality.
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