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

Abstract

Objective: to compare the outcomes of home-based (using the Heart Manual) and centre-based cardiac rehabilitation programmes.Design: randomised controlled trial and parallel economicevaluation.Setting: predominantly inner-city, multi-ethnic populationin the West Midlands, England.Patients: 525 patients referred to four hospitals forcardiac rehabilitation following myocardial infarction orcoronary revascularisation.Interventions: a home-based cardiac rehabilitation programme compared with centre-based programmes.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 (HADSanxiety and depression) and exercise capacity (incrementalshuttle walking test, ISWT) measured at 12 months. Health service resource use, quality of life utility and costs were quantified.Results: there were no significant differences in themain 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.Conclusions: a home-based cardiac rehabilitation programmedoes not produce inferior outcomes when compared to traditional centre-based programmes as provided in the United Kingdom