Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention. Clinical trial of an Internet-based case management system for secondary prevention of heart disease. Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk. Impacts of a disease management program for dually eligible beneficiaries. Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: a prospective, randomized controlled study. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease. Comparison of a rehabilitation programme, a counselling programme and usual care after an acute myocardial infarction: results of a long-term randomized trial. P.RE.COR. Group. Health-related quality of life after coronary artery bypass grafting. The impact of a randomised controlled home-based intervention program. Heart disease management by women: does intervention format matter? [Efficacy of an educational preventive technology in patients with stable angina in ambulatory conditions].
Providing information is an important part of standard care and treatment for acute myocardial infarction inpatients. Evidence exists indicating that acute myocardial infarction patients experience an information gap in the period immediately after discharge from the hospital. The aim of this study was to assess the short-term effects of a nurse-led telephone follow-up intervention to provide information and support to patients with acute myocardial infarction after their discharge from hospital.
                A prospective randomized, controlled trial with a 6-month follow-up was conducted. A total of 288 patients were allocated to either an intervention group (n=156) or a control group (n=132). The latter received routine post-discharge care. The primary endpoint measured at 3 and 6 months after discharge was the health-related quality of life using the 36-item Short Form Health Survey. Secondary endpoints included smoking and exercise habits.
                In both groups, health-related quality of life improved significantly over time on most subscales. A statistically significant difference in favour of the intervention group was found on the 36-item Short Form Health Survey Physical Health Component Summary Scale (P=0.034) after 6 months. No difference was found between the groups on the Mental Health Component Summary Scale. We found a significant difference with respect to frequency of physical activity in favour of the intervention group after 6 months (P=0.004). More participants in the intervention group than the control group had ceased smoking at the 6-month follow-up (P=0.055).
                A nurse-led systematic telephone follow-up intervention significantly improved the physical dimension of health-related quality of life in patients in the intervention group compared with usual care patients. Participation in this intervention also seemed to promote health behaviour change in patients after acute myocardial infarction. Despite demonstrated benefits of cardiac rehabilitation and risk factor reduction, only 11% to 38% of eligible patients with cardiovascular disease (CVD) participate in cardiac rehabilitation programs. Women and older adults are particularly less likely to participate in cardiac rehabilitation. In an effort to broaden access to cardiac rehabilitation, the authors developed an alternative Internet-based program that allows nurse case managers to provide risk factor management training, risk factor education, and monitoring services to patients with CVD.
                The evaluation consisted of a randomized, clinical trial involving 104 patients with CVD, 53 of whom used the program as a special intervention (SI) for 6 months and 51 of whom received usual care (UC).
                The results indicate that fewer cardiovascular events occurred among the SI subjects (15.7%) than among the UC subjects (4.1%) (P =.053), resulting in a gross cost savings of $1418 US dollars per patient. With a projected program cost of $453 USD per patient, the return on investment is estimated at 213%. More weight loss occurred in the SI group (-3.68 pounds) than in the UC group (+.47 pounds) (P =.003). The differences between the two groups in terms of blood pressure, lipid levels, depression scores, minutes of exercise, and dietary habits were not statistically significant.
                An Internet-based case management system could be used as a cost-effective intervention for patients with CVD, either independently or in conjunction with traditional cardiac rehabilitation. To assess the value of health education for patients with angina in reducing risk factors for cardiovascular disease and lessening the effect of angina on everyday activities.
                Randomised controlled trial of personal health education given every four months.
                18 general practices in the greater Belfast area.
                688 patients aged less than 75 years and known to have had angina for at least six months; 342 randomised to receive education and 346 to no education.
                Restriction of everyday activities, dietary habit, smoking habit, frequency of physical exercise; blood pressure, body mass index, and serum total cholesterol concentration at entry to trial and after two years.
                317 in the intervention group and 300 in the control group completed the trial. At the two year review more of the intervention group (140, 44%) reported taking daily physical exercise than the control group (70, 24%). The intervention group also reported eating a healthier diet than the control group and less restriction by angina in any everyday activity. No significant differences were found between the groups in smoking habit, systolic or diastolic blood pressure, cholesterol concentration, or body mass index.
                Despite having no significant effect on objective cardiovascular risk factors, personal health education of patients with angina seems to increase exercise and improve dietary habits and is effective in lessening the restriction of everyday activities. The LifeMasters Supported SelfCare demonstration program provides disease management (DM) services to Florida Medicare beneficiaries who are also enrolled in Medicaid and have congestive heart failure (CHF), diabetes, or coronary artery disease (CAD). The population-based program provides primarily telephonic patient education and monitoring services. Findings from the randomized, intent-to-treat design over the first 18 months of operations show virtually no overall impacts on hospital or emergency room (ER) use, Medicare expenditures, quality of care, or prescription drug use for the 33,000 enrollees. However, for beneficiaries with CHF who resided in high-cost South Florida counties, the program reduced Medicare expenditures by 9.6 percent. A group of 93 coronary patients recently treated with percutaneous transluminal coronary angioplasty (PTCA) were randomly assigned to either an intervention or a control group. Subjects in the intervention group participated in a comprehensive behaviorally oriented program aimed at achieving significant long-term changes in risk factor-related lifestyle behavior. Assessments of lifestyle behaviors, psychological factors, biological risk factors, and rehabilitation as well as secondary prevention endpoints were carried out, at inclusion and after 12 months. Results showed that the intervention patients, as compared with controls, improved significantly on measures assessing smoking, exercise, and diet habits. These self-rated changes were confirmed by weight reductions and improved exercise capacity, as well as by between-group differences in subclinical chest pain during an exercise test. However, few effects were found on the different psychological variables, as well as on morbidity or return to work. Medicare expenditures of patients with chronic illnesses might be reduced through improvements in care, patient adherence, and communication.
                To determine whether care coordination programs reduced hospitalizations and Medicare expenditures and improved quality of care for chronically ill Medicare beneficiaries.
                Eligible fee-for-service Medicare patients (primarily with congestive heart failure, coronary artery disease, and diabetes) who volunteered to participate between April 2002 and June 2005 in 15 care coordination programs (each received a negotiated monthly fee per patient from Medicare) were randomly assigned to treatment or control (usual care) status. Hospitalizations, costs, and some quality-of-care outcomes were measured with claims data for 18 309 patients (n = 178 to 2657 per program) from patients' enrollment through June 2006. A patient survey 7 to 12 months after enrollment provided additional quality-of-care measures.
                Nurses provided patient education and monitoring (mostly via telephone) to improve adherence and ability to communicate with physicians. Patients were contacted twice per month on average; frequency varied widely.
                Hospitalizations, monthly Medicare expenditures, patient-reported and care process indicators.
                Thirteen of the 15 programs showed no significant (P<.05) differences in hospitalizations; however, Mercy had 0.168 fewer hospitalizations per person per year (90% confidence interval [CI], -0.283 to -0.054; 17% less than the control group mean, P=.02) and Charlestown had 0.118 more hospitalizations per person per year (90% CI, 0.025-0.210; 19% more than the control group mean, P=.04). None of the 15 programs generated net savings. Treatment group members in 3 programs (Health Quality Partners [HQP], Georgetown, Mercy) had monthly Medicare expenditures less than the control group by 9% to 14% (-$84; 90% CI, -$171 to $4; P=.12; -$358; 90% CI, -$934 to $218; P=.31; and -$112; 90% CI, -$231 to $8; P=.12; respectively). Savings offset fees for HQP and Georgetown but not for Mercy; Georgetown was too small to be sustainable. These programs had favorable effects on none of the adherence measures and only a few of many quality of care indicators examined.
                Viable care coordination programs without a strong transitional care component are unlikely to yield net Medicare savings. Programs with substantial in-person contact that target moderate to severe patients can be cost-neutral and improve some aspects of care.
                clinicaltrials.gov Identifier: NCT00627029. The aim of cardiac rehabilitation (CR) is not only physical improvement but also increased quality of life (QoL). A CR programme based upon problem based learning (PBL) philosophy was developed, to achieve and apply new knowledge related to coronary artery disease (CAD). The aim of this paper was to evaluate the impact of the PBL programme on QoL.
                207 consecutive patients <70 years of age with a recent event of CAD were randomised to a PBL group (n=104) or a control group (n=103). In addition to standard treatment, the PBL patients participated in 13 group sessions during 1 year, where individual learning needs and behavioural changes were focused upon. QoL was measured by the Ladder of Life, Self-Rated Health (SRH), SF 36, and Cardiac Health Profile (CHP).
                Significant differences between the groups, favouring the PBL patients, were found by global instruments: more optimistic expectations of the future QoL and a better general condition. No differences were found by SRH, SF 36 or subscales of CHP, but QoL increased in both groups during the year.
                The main outcome was that QoL improved in both groups with some effects favouring the PBL programme. One hundred and eighty-two male post myocardial infarction patients under 65 years old were randomized 30 to 60 days after the acute event into a 6-week rehabilitation programme (RP), a counselling programme without exercise training training (CP) and usual care (UC). Follow-up visits and exercise tests on a bicycle ergometer were performed 2, 12 and 24 months after randomization. Baseline characteristics were identical in the three groups. The percentage of patients reaching the maximal heart rate at exercise test was higher in the RP group even after 2 years (UC = 24%, CP = 13%, RP = 50%, P = 0.001). The number of deaths at 2 years was respectively 4, 5 and 0 in the UC, CP and RP groups (P = 0.08). If UC and CP groups are combined and tested against RP the difference is statistically significant (P = 0.03). Reinfarction rates were similar in the three groups (UC = 10%, CP = 7%, RP = 7%). This study confirms that a rehabilitation programme seems worth recommending in young patients with uncomplicated myocardial infarction. The aim of this study was to evaluate the impact of a home based intervention program (HBIP) on health related quality of life (HRQoL) after coronary artery bypass grafting (CABG). To strengthen the clinical interpretation, HRQoL data were compared to the general population.
                In a randomised controlled trial (RCT), a total of 185 CABG patients (93 vs 92) completed the study. The intervention group received a HBIP 2 and 4 weeks after surgery. HRQoL was measured by the Seattle Angina Questionnaire (SAQ) and the Short Form 36 (SF-36) in both patient groups before surgery, at 6 weeks and 6 months after surgery.
                Significant improvements were found in both groups for the majority of subscales of HRQoL at 6-week and 6-month follow-up. However, these improvements did not differ significantly between the groups. Compared to the general population, significant differences (P < 0.05) were found for the SF-36 subscales: role physical, role emotional and bodily pain.
                HRQoL after CABG improved markedly over time, but no significant or clinically important differences were found when compared with controls. Thus, work to further develop and test the effect of a HBIP on HRQoL in patients undergoing rehabilitation following CABG is warranted. A randomized controlled trial of two formats of a program (Women Take PRIDE) to enhance management of heart disease by patients was conducted. Older women (N = 575) were randomly assigned to a group or self-directed format or to a control group. Data regarding symptoms, functional health status, and weight were collected at baseline and at 4, 12, and 18 months. The formats produced different outcomes. At 18 months, the self-directed format was better than the control in reducing the number (p < or = .02), frequency (p < or = .03), and bothersomeness (p < or = .02) of cardiac symptoms. The self-directed format was also better than the group format in reducing symptom frequency of all types (p < or = .04). The group format improved ambulation at 12 months (p < or = .04) and weight loss at 18 months (p < or = .03), and group participants were more likely to complete the program ( p < or = .05). The availability of different learning formats could enhance management of cardiovascular disease by patients. Aim of the study was to assess efficacy of educational technology--School for patients with stable angina--in conditions of practical health care. We randomized 100 patients with ischemic heart disease (IHD) and stable FC I-III angina into 2 groups one of which went through learning in a School for patients with IHD (6 90 min sessions 2 times a week). Patients of both main and control groups were followed up for 12 months. During the whole term of the investigation in both groups observation and treatment of patients was conducted by physicians of city polyclinic in accordance with generally accepted method of care of patients with diagnosis "IHD, stable angina pectoris". Results of the investigation evidence that studying in the School for patients with stable angina significantly elevates level of medical information adopted by patients, ensures positive dynamics of the whole row of clinical and psychological parameters as well as integral parameters of quality of life of patients with IHD.
We did not find strong evidence that education reduced all cause mortality, cardiac morbidity, revascularisation or hospitalisation compared to control. There was some evidence to suggest that education may improve HRQofL and reduce overall healthcare costs. Whilst our findings are generally supportive of current guidelines that CR should include not only exercise and psychological interventions, further research into education is needed.