 |
 |
|
|
|  PubMed
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 November 2005 | Volume 143 Issue 9 | Pages 659-672
Background: Although supervised exercise programs reduce mortality in survivors of myocardial infarction, the effects of other types of cardiac secondary prevention programs are unknown.
Purpose: To determine the effectiveness of secondary cardiac prevention programs with and without exercise components.
Data Sources: The authors searched MEDLINE (1966–2004), the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, SIGLE, and the Cochrane Effective Practice and Organization of Care Study Registry. They also contacted primary study authors and hand-searched bibliographies provided by the Centers for Medicare & Medicaid Services.
Study Selection: Randomized clinical trials.
Data Extraction: Two reviewers chose studies and extracted data independently; random-effects summary risk ratios were calculated.
Data Synthesis: The authors identified 63 randomized trials (21 295 patients with coronary disease). The summary risk ratio was 0.85 (95% CI, 0.77 to 0.94) for all-cause mortality, but this result differed over time with a risk ratio of 0.97 (CI, 0.82 to 1.14) at 12 months and 0.53 (CI, 0.35 to 0.81) at 24 months. The summary risk ratio was 0.83 (CI, 0.74 to 0.94) for recurrent myocardial infarction over a median follow-up of 12 months. Effects were similar for programs that included risk factor education or counseling with a structured exercise component (risk ratio, 0.88 [CI, 0.74 to 1.04] for mortality and 0.62 [CI, 0.44 to 0.87] for myocardial infarction), for programs that included risk factor education or counseling without an exercise component (risk ratio, 0.87 [CI, 0.76 to 0.99] for mortality and 0.86 [CI, 0.72 to 1.03] for myocardial infarction), and for programs that were solely exercise-based (risk ratio, 0.72 [CI, 0.54 to 0.95] for mortality and 0.76 [CI, 0.57 to 1.01] for myocardial infarction). Most of these programs improved quality of life or functional status, but effect sizes were small.
Limitations: Although these programs may reduce total health care costs, published data on the costs of the programs are inadequate to conclusively comment on their cost-effectiveness.
Conclusions: A wide variety of secondary prevention programs improve health outcomes in patients with coronary disease.
Author and Article Information
From the University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada.
Disclaimer: No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank Dr. N.C. Campbell (13, 14), Dr. R. West (49), Dr. M. Naylor (27, 53), Dr. N. Marchionni (47), Drs. Vale and Sundararajan (63), Dr. Otterstad and Ms. Peersen (46), Dr. W. Young (65), and Dr. K. Jolly (39) for providing further details about their studies. The authors also thank the staff of the University of Alberta Evidence-based Practice Center who participated in generating this report: C. Friesen, J. Russell, M. Josefsson, N. Wiebe, M. Tubman, and K. Bond.
Grant Support: This evidence report was produced by the University of Alberta Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-02-0023). Drs. Clark and McAlister hold salary awards from the Alberta Heritage Foundation for Medical Research. Dr. McAlister also holds a Canadian Institutes of Health Research New Investigator Award and the Merck Frosst/Aventis Chair in Patient Health Management at the University of Alberta.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Finlay A. McAlister, MD, MSc, Division of General Internal Medicine, 2E3.24 WMC, University of Alberta Hospital, 8440 112th Street, Edmonton T6G 2R7, Alberta, Canada; e-mail, Finlay.McAlister{at}ualberta.ca.
Current Author Addresses: Dr. Clark: Fourth Floor, Faculty of Nursing, Clinical Sciences Building, University of Alberta, Edmonton TGR 2G3, Alberta, Canada.
Ms. Hartling and Mr. Vandermeer: Alberta Research Centre for Child Health Evidence, Aberhart Building, University of Alberta, 11402 University Avenue, Edmonton T6G 2J3, Alberta, Canada.
Dr. McAlister: Division of General Internal Medicine, 2E3.24 WMC, University of Alberta Hospital, 8440 112th Street, Edmonton T6G 2R7, Alberta, Canada. REVIEW
Meta-Analysis: Secondary Prevention Programs for Patients with Coronary Artery Disease
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  J. A. Suaya, W. B. Stason, P. A. Ades, S.-L. T. Normand, and D. S. Shepard Cardiac rehabilitation and survival in older coronary patients. J. Am. Coll. Cardiol., June 30, 2009; 54(1): 25 - 33. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Stukel and D. A. Alter Analysis methods for observational studies effects of cardiac rehabilitation on mortality of coronary patients. J. Am. Coll. Cardiol., June 30, 2009; 54(1): 34 - 35. [Full Text] [PDF]
|
|
|
|
 |
|
 V. S. Conn, A. R. Hafdahl, P. S. Cooper, T. M. Ruppar, D. R. Mehr, and C. L. Russell Interventions to Improve Medication Adherence Among Older Adults: Meta-Analysis of Adherence Outcomes Among Randomized Controlled Trials Gerontologist, May 21, 2009; (2009) gnp037v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R Thompson Cardiac rehabilitation: Adding years to life and life to years Journal of Research in Nursing, May 1, 2009; 14(3): 207 - 219. [Abstract] [PDF]
|
|
|
|
 |
|
 M. V Jelinek Exercise: the neglected risk factor and the neglected treatment Heart, March 1, 2009; 95(6): 441 - 441. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Peikes, A. Chen, J. Schore, and R. Brown Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials JAMA, February 11, 2009; 301(6): 603 - 618. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Bethell, R Lewin, and H Dalal Cardiac rehabilitation in the United Kingdom Heart, February 1, 2009; 95(4): 271 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz, J. L. Anderson, B. L. Bachelder, F. M. Fesmire, S. D. Fihn, J. M. Foody, P. M. Ho, M. N. Kosiborod, F. A. Masoudi, and B. K. Nallamothu ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction) Developed in Collaboration With the American Academy of Family Physicians and American College of Emergency Physicians Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine J. Am. Coll. Cardiol., December 9, 2008; 52(24): 2046 - 2099. [Full Text] [PDF]
|
|
|
|
 |
|
 H. M. Krumholz, J. L. Anderson, B. L. Bachelder, F. M. Fesmire, S. D. Fihn, J. M. Foody, P. M. Ho, M. N. Kosiborod, F. A. Masoudi, and B. K. Nallamothu ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction): Developed in Collaboration With the American Academy of Family Physicians and the American College of Emergency Physicians: Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine Circulation, December 9, 2008; 118(24): 2596 - 2648. [Full Text] [PDF]
|
|
|
|
|
|
E K Delaney, P Murchie, A J Lee, L D Ritchie, and N C Campbell Secondary prevention clinics for coronary heart disease: a 10-year follow-up of a randomised controlled trial in primary care Heart, November 1, 2008; 94(11): 1419 - 1423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Auer, J. Gaume, N. Rodondi, J. Cornuz, and W. A. Ghali Efficacy of In-Hospital Multidimensional Interventions of Secondary Prevention After Acute Coronary Syndrome: A Systematic Review and Meta-Analysis Circulation, June 17, 2008; 117(24): 3109 - 3117. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Clark Commentary by Clark West J Nurs Res, June 1, 2008; 30(4): 491 - 494. [PDF]
|
|
|
|
|
|
N. K. Wenger Current Status of Cardiac Rehabilitation J. Am. Coll. Cardiol., April 29, 2008; 51(17): 1619 - 1631. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C E. Pluss, M R. Karlsson, N. Wallen, E. Billing, and C. Held Effects of an expanded cardiac rehabilitation programme in patients treated for an acute myocardial infarction or a coronary artery by-pass graft operation Clinical Rehabilitation, April 1, 2008; 22(4): 306 - 318. [Abstract] [PDF]
|
|
|
|
 |
|
 G. S. Metsios, A. Stavropoulos-Kalinoglou, J. J. C. S. Veldhuijzen van Zanten, G. J. Treharne, V. F. Panoulas, K. M. J. Douglas, Y. Koutedakis, and G. D. Kitas Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review Rheumatology, March 1, 2008; 47(3): 239 - 248. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Linden, M. J. Phillips, and J. Leclerc Psychological treatment of cardiac patients: a meta-analysis Eur. Heart J., December 2, 2007; 28(24): 2972 - 2984. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Thomas Cardiac Rehabilitation/Secondary Prevention Programs: A Raft for the Rapids: Why Have We Missed the Boat? Circulation, October 9, 2007; 116(15): 1644 - 1646. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Suaya, D. S. Shepard, S.-L. T. Normand, P. A. Ades, J. Prottas, and W. B. Stason Use of Cardiac Rehabilitation by Medicare Beneficiaries After Myocardial Infarction or Coronary Bypass Surgery Circulation, October 9, 2007; 116(15): 1653 - 1662. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Thomas, M. King, K. Lui, N. Oldridge, I. L. Pina, J. Spertus, R. O. Bonow, N.A. M. Estes III, D. C. Goff, K. L. Grady, et al. AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services: Endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1400 - 1433. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Clark, P. D. MacIntyre, and J. Cruickshank A critical realist approach to understanding and evaluating heart health programmes Health (London) , October 1, 2007; 11(4): 513 - 539. [Abstract] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, I. Graham, D. Atar, K. Borch-Johnsen, G. Boysen, G. Burell, R. Cifkova, J. Dallongeville, G. De Backer, S. Ebrahim, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts) Eur. Heart J., October 1, 2007; 28(19): 2375 - 2414. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Davis, L. M. Vinci, T. M. Okwuosa, A. R. Chase, and E. S. Huang Cardiovascular Health Disparities: A Systematic Review of Health Care Interventions Med Care Res Rev, October 1, 2007; 64(5_suppl): 29S - 100S. [Abstract] [PDF]
|
|
|
|
 |
|
 D. G. Hackam and J. D. Spence Combining Multiple Approaches for the Secondary Prevention of Vascular Events After Stroke: A Quantitative Modeling Study Stroke, June 1, 2007; 38(6): 1881 - 1885. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A F Cooper, J Weinman, M Hankins, G Jackson, and R Horne Assessing patients' beliefs about cardiac rehabilitation as a basis for predicting attendance after acute myocardial infarction Heart, January 1, 2007; 93(1): 53 - 58. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kligfield and M. S. Lauer Exercise Electrocardiogram Testing: Beyond the ST Segment Circulation, November 7, 2006; 114(19): 2070 - 2082. [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. Rosenfeld State of the Heart: Building Science to Improve Women's Cardiovascular Health Am. J. Crit. Care., November 1, 2006; 15(6): 556 - 566. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Harbman Review: secondary prevention programmes with and without exercise reduced all cause mortality and recurrent myocardial infarction Evid. Based Nurs., July 1, 2006; 9(3): 77 - 77. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Lancaster Review: secondary prevention programmes with and without exercise reduce all cause mortality and recurrent MI Evid. Based Med., June 1, 2006; 11(3): 87 - 87. [Full Text] [PDF]
|
|
|
|
 |
|
 M.J. Cohen, A. Pollak, A.T. Weiss, and M. Brezis Availability bias in the management of myocardial infarction QJM, January 1, 2006; 99(1): 64 - 65. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Tonks What's new in the other general journals BMJ, November 12, 2005; 331(7525): 1105 - 1106. [Full Text] [PDF]
|
|
