Cardiac rehabilitation programmes improve outcomes and lifestyles
The EUROACTION study provides some of the most impressive evidence to date that cardiac rehabilitation programmes are beneficial and should be readily available.
The EUROACTION study was a randomised, controlled trial based in eight European countries that evaluated the effect of cardiac rehabilitation programmes in both primary and secondary care.
More than 3,000 patients in secondary care with established CHD and 2,317 patients in the community at high risk of CVD were randomly assigned to care as usual or a nurse-coordinated, multidisciplinary, family-based cardiac rehabilitation programme (see table 1, below).
However, there was a significant improvement in the intervention group in reducing consumption of saturated fat (55% versus 40%, P=0.009) and increasing consumption of fruit and vegetables (72% versus 35%, P=0.004) and oily fish (17% versus 8%, P=0.04) compared with the usual care group. There was also a significant improvement in achieving a blood pressure of <140/90mmHg (65% versus 55%, P=0.04) but no significant difference in achieving the total cholesterol target of <5mmol between the two groups.
The high CVD risk group and their partners assigned to the intervention showed significant increases in fruit and vegetable intake (P=0.005 and P=0.002 respectively). The number of patients achieving a blood pressure target of <140/90mmHg was also significantly higher (P=0.03) than those in the care as usual group.
The numbers of patients prescribed statins in both primary and secondary care and ACE inhibitors in primary care were significantly higher in the intervention groups.
This study has shown the impact that cardiac rehabilitation programmes can have and even in areas where statistical significance was not achieved the trends were encouraging. At present, large numbers of patients with coronary disease are not offered cardiac rehabilitation despite such benefits.
The inclusion of family-based prevention was an interesting and important area in this study, as the impetus for lifestyle change will surely be greater in a favourable family environment.
Wood DA, Kotseva K, Connolly S et al. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet 2008;371:1999-2012tab1_EUROACTION Reviewer
Dr Peter Savill
GPwSI Cardiology, Southampton