Acute Coronary Syndrome, Acute Myocardial Infarction: Rehabilitation Phase, Myocardial Ischemia
Conditions
Keywords
Acute Coronary Syndrome, Myocardial Ischemia, Shared Care, Rehabilitation, Community, Cardiac Rehabilitation, Hospital
Brief summary
Cardiac rehabilitation is an individual adapted multidisciplinary intervention for people suffering from Heart Disease. It involves; * Dietary counseling, * Exercise training, * Psychosocial support, * Physician * smoking cessation * Patient education The purpose is quick and complete recovery and to reduce the chance of recurrence. In Denmark people admitted with Acute Cardiac Disease is referred to a course of hospital based cardiac rehabilitation at discharge. The Danish Municipal Reform of 2007 changed the responsibility of rehabilitation from the Regions, who runs the hospitals, to the municipalities. Shared care is in this setting that elements of treatment are completed different places in Health Care. The aim of this study is: * to establish a shared care model for Cardiac rehabilitation following admission with Acute Coronary Syndrome and * to compare this model to the existing hospital based cardiac rehabilitation after admission with Acute Coronary Syndrome. Primary outcome is participation in cardiac rehabilitation.
Interventions
BEHAVIORALShared Care model
* First visit at cardiac ambulatory approximately 14 days after discharge includes physician examination by cardiologist and counseling from nurse specialized in cardiac rehabilitation. * Dietary counseling with dietician * Exercise (1 hour, 2 timer pr week for 12 weeks) * Smoking cessation if smoker with educated smoking cessation instructor * Patient education and psychosocial support in 2 individual consultations and 8 group based consultations with experienced nurse * Examination by the patient´s general practitioner 8-12 weeks after discharge.
Sponsors
Region MidtJylland Denmark
University of Aarhus
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* Admission with Acute Coronary Syndrome * Resident in district of Department of Cardiology, Aarhus University Hospital, Silkeborg or Viborg Hospital, part of the Hospitalsenheden Midt Viborg, Silkeborg, Skive, Hammel. * Accept both models of cardiac rehabilitation * written informed consent
Exclusion criteria
* Resident outside the district of Department of Cardiology, Aarhus University Hospital, Viborg Hospital or Silkeborg Hospital, part of Hospitalsenheden Midt (Viborg, Silkeborg, Skive, Hammel). * Age 80 years or older * Heart Failure (Ejection Fraction less than 40%) * Severe Comorbidity * Resuscitated and need of support from ergotherapist after discharge.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participation in cardiac rehabilitation | 4 months | Participation in cardiac rehabilitation is evaluated for each element. Participation is defined as at least 50% for each element. * Smoking cessation * Dietary counseling * Exercise training * Physician * Patient education * Psychosocial support Full participation is in 6 of 6 elements if smoker or 5/5 if non-smoker. Partial full participation is in 5/6 if smoker or 4/5 if non-smoker. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 24-hour Ambulatory Blood Pressure | 4 og 12 months | — |
| Blood Cholesterol values (Total, LDL, HDL) | 4 and 12 months | — |
| Fasting Blood glucose | 4 and 12 months | — |
| Exercise Capacity | 4 and 12 months | — |
| Lifestyle changes | 4 and 12 months | Diet, Physical Activity, Smoking, Alcohol consumption. |
| Change of BMI and / or abdominal circumference | 4 and 12 months | — |
| Compliance to pharmaceutical treatment | 4 and 12 months | — |
| Readmission | 4 and 12 months | Total and cardiovascular |
| Change in Health Related Quality of Living | 4 and 12 months | SF-12 HeartQoL EQ-5D |
| Difference in Health economic costs | 4 and 12 months | — |
| Depression score | 4 and 12 months | Estimated by Hospital Anxiety and Depression Scale |
Countries
Denmark
Outcome results
None listed