Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS)

H. M. Dalal; P. H. Evans; J. L. Campbell; R. S. Taylor; A. Watt; K. L.Q. Read; A. J. Mourant; J. Wingham; David, R Thompson; D. J.Pereira Gray

doi:10.1016/j.ijcard.2006.11.018

Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS)

H. M. Dalal^*, P. H. Evans, J. L. Campbell, R. S. Taylor, A. Watt, K. L.Q. Read, A. J. Mourant, J. Wingham, David, R Thompson , D. J.Pereira Gray

^*Corresponding author for this work

School of Nursing and Midwifery

Research output: Contribution to journal › Article › peer-review

125 Citations (Scopus)

Abstract

Background: Participation in cardiac rehabilitation after acute myocardial infarction is sub-optimal. Offering home-based rehabilitation may improve uptake. We report the first randomized study of cardiac rehabilitation to include patient preference. Aim: To compare the clinical effectiveness of a home-based rehabilitation with hospital-based rehabilitation after myocardial infarction and to determine whether patient choice affects clinical outcomes. Design: Pragmatic randomized controlled trial with patient preference arms. Setting: Rural South West England. Methods: Patients admitted with uncomplicated myocardial infarction were offered hospital-based rehabilitation classes over 8-10 weeks or a self-help package of six weeks' duration (the Heart Manual) supported by a nurse. Primary outcomes at 9 months were mean depression and anxiety scores on the Hospital Anxiety Depression scale, quality of life after myocardial infarction (MacNew) score and serum total cholesterol. Results: Of the 230 patients who agreed to participate, 104 (45%) consented to randomization and 126 (55%) chose their rehabilitation programme. Nine month follow-up data were available for 84/104 (81%) randomized and 100/126 (79%) preference patients. At follow-up no difference was seen in the change in mean depression scores between the randomized home and hospital-based groups (mean difference: 0; 95% confidence interval, - 1.12 to 1.12) nor mean anxiety score (- 0.07; - 1.42 to 1.28), mean global MacNew score (0.14; - 0.35 to 0.62) and mean total cholesterol levels (- 0.18; - 0.62 to 0.27). Neither were there any significant differences in outcomes between the preference groups. Conclusions: Home-based cardiac rehabilitation with the Heart Manual was as effective as hospital-based rehabilitation for patients after myocardial infarction. Choosing a rehabilitation programme did not significantly affect clinical outcomes.

Original language	English
Pages (from-to)	202-211
Number of pages	10
Journal	International Journal of Cardiology
Volume	119
Issue number	2
DOIs	https://doi.org/10.1016/j.ijcard.2006.11.018
Publication status	Published - 10 Jul 2007

Keywords

Cardiac rehabilitation
Myocardial infarction
Patient preference
Randomized trial

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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Dalal, H. M., Evans, P. H., Campbell, J. L., Taylor, R. S., Watt, A., Read, K. L. Q., Mourant, A. J., Wingham, J., Thompson , D. R., & Gray, D. J. P. (2007). Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS). International Journal of Cardiology, 119(2), 202-211. https://doi.org/10.1016/j.ijcard.2006.11.018

Dalal, H. M. ; Evans, P. H. ; Campbell, J. L. ; Taylor, R. S. ; Watt, A. ; Read, K. L.Q. ; Mourant, A. J. ; Wingham, J. ; Thompson , David, R ; Gray, D. J.Pereira. / Home-based versus hospital-based rehabilitation after myocardial infarction : A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS). In: International Journal of Cardiology. 2007 ; Vol. 119, No. 2. pp. 202-211.

@article{26e17714fe824669b3bce44ecf19395f,

title = "Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS)",

abstract = "Background: Participation in cardiac rehabilitation after acute myocardial infarction is sub-optimal. Offering home-based rehabilitation may improve uptake. We report the first randomized study of cardiac rehabilitation to include patient preference. Aim: To compare the clinical effectiveness of a home-based rehabilitation with hospital-based rehabilitation after myocardial infarction and to determine whether patient choice affects clinical outcomes. Design: Pragmatic randomized controlled trial with patient preference arms. Setting: Rural South West England. Methods: Patients admitted with uncomplicated myocardial infarction were offered hospital-based rehabilitation classes over 8-10 weeks or a self-help package of six weeks' duration (the Heart Manual) supported by a nurse. Primary outcomes at 9 months were mean depression and anxiety scores on the Hospital Anxiety Depression scale, quality of life after myocardial infarction (MacNew) score and serum total cholesterol. Results: Of the 230 patients who agreed to participate, 104 (45%) consented to randomization and 126 (55%) chose their rehabilitation programme. Nine month follow-up data were available for 84/104 (81%) randomized and 100/126 (79%) preference patients. At follow-up no difference was seen in the change in mean depression scores between the randomized home and hospital-based groups (mean difference: 0; 95% confidence interval, - 1.12 to 1.12) nor mean anxiety score (- 0.07; - 1.42 to 1.28), mean global MacNew score (0.14; - 0.35 to 0.62) and mean total cholesterol levels (- 0.18; - 0.62 to 0.27). Neither were there any significant differences in outcomes between the preference groups. Conclusions: Home-based cardiac rehabilitation with the Heart Manual was as effective as hospital-based rehabilitation for patients after myocardial infarction. Choosing a rehabilitation programme did not significantly affect clinical outcomes.",

keywords = "Cardiac rehabilitation, Myocardial infarction, Patient preference, Randomized trial",

author = "Dalal, {H. M.} and Evans, {P. H.} and Campbell, {J. L.} and Taylor, {R. S.} and A. Watt and Read, {K. L.Q.} and Mourant, {A. J.} and J. Wingham and Thompson, {David, R} and Gray, {D. J.Pereira}",

year = "2007",

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doi = "10.1016/j.ijcard.2006.11.018",

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Dalal, HM, Evans, PH, Campbell, JL, Taylor, RS, Watt, A, Read, KLQ, Mourant, AJ, Wingham, J, Thompson , DR & Gray, DJP 2007, 'Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS)', International Journal of Cardiology, vol. 119, no. 2, pp. 202-211. https://doi.org/10.1016/j.ijcard.2006.11.018

Home-based versus hospital-based rehabilitation after myocardial infarction : A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS). / Dalal, H. M.; Evans, P. H.; Campbell, J. L.; Taylor, R. S.; Watt, A.; Read, K. L.Q.; Mourant, A. J.; Wingham, J.; Thompson , David, R; Gray, D. J.Pereira.

In: International Journal of Cardiology, Vol. 119, No. 2, 10.07.2007, p. 202-211.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Home-based versus hospital-based rehabilitation after myocardial infarction

T2 - A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS)

AU - Dalal, H. M.

AU - Evans, P. H.

AU - Campbell, J. L.

AU - Taylor, R. S.

AU - Watt, A.

AU - Read, K. L.Q.

AU - Mourant, A. J.

AU - Wingham, J.

AU - Thompson , David, R

AU - Gray, D. J.Pereira

PY - 2007/7/10

Y1 - 2007/7/10

N2 - Background: Participation in cardiac rehabilitation after acute myocardial infarction is sub-optimal. Offering home-based rehabilitation may improve uptake. We report the first randomized study of cardiac rehabilitation to include patient preference. Aim: To compare the clinical effectiveness of a home-based rehabilitation with hospital-based rehabilitation after myocardial infarction and to determine whether patient choice affects clinical outcomes. Design: Pragmatic randomized controlled trial with patient preference arms. Setting: Rural South West England. Methods: Patients admitted with uncomplicated myocardial infarction were offered hospital-based rehabilitation classes over 8-10 weeks or a self-help package of six weeks' duration (the Heart Manual) supported by a nurse. Primary outcomes at 9 months were mean depression and anxiety scores on the Hospital Anxiety Depression scale, quality of life after myocardial infarction (MacNew) score and serum total cholesterol. Results: Of the 230 patients who agreed to participate, 104 (45%) consented to randomization and 126 (55%) chose their rehabilitation programme. Nine month follow-up data were available for 84/104 (81%) randomized and 100/126 (79%) preference patients. At follow-up no difference was seen in the change in mean depression scores between the randomized home and hospital-based groups (mean difference: 0; 95% confidence interval, - 1.12 to 1.12) nor mean anxiety score (- 0.07; - 1.42 to 1.28), mean global MacNew score (0.14; - 0.35 to 0.62) and mean total cholesterol levels (- 0.18; - 0.62 to 0.27). Neither were there any significant differences in outcomes between the preference groups. Conclusions: Home-based cardiac rehabilitation with the Heart Manual was as effective as hospital-based rehabilitation for patients after myocardial infarction. Choosing a rehabilitation programme did not significantly affect clinical outcomes.

AB - Background: Participation in cardiac rehabilitation after acute myocardial infarction is sub-optimal. Offering home-based rehabilitation may improve uptake. We report the first randomized study of cardiac rehabilitation to include patient preference. Aim: To compare the clinical effectiveness of a home-based rehabilitation with hospital-based rehabilitation after myocardial infarction and to determine whether patient choice affects clinical outcomes. Design: Pragmatic randomized controlled trial with patient preference arms. Setting: Rural South West England. Methods: Patients admitted with uncomplicated myocardial infarction were offered hospital-based rehabilitation classes over 8-10 weeks or a self-help package of six weeks' duration (the Heart Manual) supported by a nurse. Primary outcomes at 9 months were mean depression and anxiety scores on the Hospital Anxiety Depression scale, quality of life after myocardial infarction (MacNew) score and serum total cholesterol. Results: Of the 230 patients who agreed to participate, 104 (45%) consented to randomization and 126 (55%) chose their rehabilitation programme. Nine month follow-up data were available for 84/104 (81%) randomized and 100/126 (79%) preference patients. At follow-up no difference was seen in the change in mean depression scores between the randomized home and hospital-based groups (mean difference: 0; 95% confidence interval, - 1.12 to 1.12) nor mean anxiety score (- 0.07; - 1.42 to 1.28), mean global MacNew score (0.14; - 0.35 to 0.62) and mean total cholesterol levels (- 0.18; - 0.62 to 0.27). Neither were there any significant differences in outcomes between the preference groups. Conclusions: Home-based cardiac rehabilitation with the Heart Manual was as effective as hospital-based rehabilitation for patients after myocardial infarction. Choosing a rehabilitation programme did not significantly affect clinical outcomes.

KW - Cardiac rehabilitation

KW - Myocardial infarction

KW - Patient preference

KW - Randomized trial

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ER -

Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS)

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