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The Birmingham rehabilitation uptake maximisation study (BRUM): a randomised controlled trial comparing home-based with centre-based cardiac rehabilitation

By K. Jolly, G.Y.H. Lip, R.S. Taylor, J. Raftery, J. Mant, D. Lane, S. Greenfield and A. Stevens

Abstract

Objective: to compare the outcomes of home-based (using the Heart Manual) and centre-based cardiac rehabilitation programmes.<br/><br/>Design: randomised controlled trial and parallel economic<br/>evaluation.<br/><br/>Setting: predominantly inner-city, multi-ethnic population<br/>in the West Midlands, England.<br/><br/>Patients: 525 patients referred to four hospitals for<br/>cardiac rehabilitation following myocardial infarction or<br/>coronary revascularisation.<br/><br/>Interventions: a home-based cardiac rehabilitation programme compared with centre-based programmes.<br/><br/>Main outcome measures: smoking cessation, blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), total cholesterol (TC) and high-density lipoprotein (HDL)-cholesterol, psychological status (HADS<br/>anxiety and depression) and exercise capacity (incremental<br/>shuttle walking test, ISWT) measured at 12 months. Health service resource use, quality of life utility and costs were quantified.<br/><br/>Results: there were no significant differences in the<br/>main outcomes when the home-based was compared with the centre-based programme at 12 months. Adjusted mean difference (95% CI) for SBP was 1.94 mm Hg (21.1 to 5.0); DBP 0.42 mm Hg (21.25 to 2.1); TC 0.1 mmol/l (20.05 to 0.24); HADS anxiety 20.02 (20.69 to 0.65); HADS depression 20.35 (20.95 to 0.25); distance on ISWT 221.5 m (248.3 to 5.2). The relative risk of being a smoker in the home arm was 0.90. The cost per patient to the NHS was significantly higher in the home arm at £198, (95% CI 189 to 208) compared to £157 (95% CI 139 to 175) in the centre-based arm. However when the patients’ cost of travel was included, these differences were no longer significant.<br/><br/>Conclusions: a home-based cardiac rehabilitation programme<br/>does not produce inferior outcomes when compared to traditional centre-based programmes as provided in the United Kingdom

Year: 2009
OAI identifier: oai:eprints.soton.ac.uk:147835
Provided by: e-Prints Soton
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