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Sibilitz KL, Tang LH, Berg SK, Thygesen LC, Risom SS, Rasmussen TB, Schmid JP, Borregaard B, Hassager C, Køber L, Taylor RS, Zwisler AD. Long-term effects of cardiac rehabilitation after heart valve surgery - results from the randomised CopenHeart VR trial. SCAND CARDIOVASC J 2022; 56:247-255. [PMID: 35811477 DOI: 10.1080/14017431.2022.2095432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/15/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
Aims. The CopenHeartVR trial found positive effects of cardiac rehabilitation (CR) on physical capacity at 4 months. The long-term effects of CR following valve surgery remains unclear, especially regarding readmission and mortality. Using data from he CopenHeartVR Trial we investigated long-term effects on physical capacity, mental and physical health and effect on mortality and readmission rates as prespecified in the original protocol. Methods. A total of 147 participants were included after heart valve surgery and randomly allocated 1:1 to 12-weeks exercise-based CR including a psycho-educational programme (intervention group) or control. Physical capacity was assessed as peak oxygen uptake (VO2 peak) measured by cardiopulmonary exercise testing, mental and physical health by Short Form-36 questionnaire, Hospital Anxiety and Depression Scale, and HeartQol. Mortality and readmission were obtained from hospital records and registers. Groups were compared using mixed regression model analysis and log rank test. Results. No differences in VO2 peak at 12 months or in self-assessed mental and physical health at 24 months (68% vs 75%, p = .120) was found. However, our data demonstrated reduction in readmissions in the intervention group at intermediate time points; after 3, 6 (43% vs 59%, p = .03), and 12 (53% vs 67%, p = .04) months, respectively, but no significant effect at 24 months. Conclusions. Exercise-based CR after heart valve surgery reduces combined readmissions and mortality up to 12 months despite lack of improvement in exercise capacity, physical and mental health long-term. Exercise-based CR can ensure short-term benefits in terms of physical capacity, and lower readmission within a year, but more research is needed to sustain these effects over a longer time period. These considerations should be included in the management of patients after heart valve surgery.
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Affiliation(s)
- Kirstine L Sibilitz
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Hermann Tang
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care and University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Signe Stelling Risom
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute for Nursing and Nutrition, University College Copenhagen, Tagensvej, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Jean-Paul Schmid
- Swiss Cardiovascular Centre Bern, Cardiovascular Prevention and Rehabilitation Unit, University Hospital, Bern, Switzerland
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Ann-Dorthe Zwisler
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care and University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Borregaard B, Møller JE, Dahl JS, Riber LPS, Berg SK, Ekholm O, Weiss MG, Lykking EK, Sibilitz KL, Sørensen J. Early follow-up after open heart valve surgery reduces healthcare costs: a propensity matched study. Open Heart 2019; 6:e001122. [PMID: 31798915 PMCID: PMC6861062 DOI: 10.1136/openhrt-2019-001122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/15/2019] [Accepted: 10/30/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives The objective was to assess differences in healthcare costs within 180 days after discharge from open heart valve surgery in an intervention group receiving early, individualised and intensified follow-up compared with a historical control group. Methods A cost-minimisation analysis comparing costs from a consecutive prospective cohort compared with a propensity matched cohort. Costs related to the intervention, hospital (outpatient visits and readmissions) and general practitioners (all contacts) were included. Data were obtained from electronic patient records and registry data. A logistic propensity model was used to identify the historical control group. Main results are presented as mean differences and 95% CIs based on bootstrapping. Results After matching, the analysis included 300 patients from the intervention group and 580 controls. The mean intervention cost was €171 (SD 79) per patient. After 180 days, the mean healthcare costs were €1284 (SD 2567) for the intervention group and €2077 (SD 4773) for the controls. The cost of the intervention group was €793 (p<0.001) less per patient. The cost differences were explained mainly by fewer readmissions, fewer overall emergency visits and fewer contacts to the general practitioner during out-of-hours in the intervention group. Conclusions The intervention consisting of early, individualised and intensified follow-up after open heart valve surgery significantly reduced the healthcare costs within 180 days after discharge.
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Affiliation(s)
- Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Jacob Eifer Møller
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense Universitetshospital, Odense, Denmark
| | - Jordi Sanchez Dahl
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense Universitetshospital, Odense, Denmark
| | - Lars Peter Schødt Riber
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Thoracic Surgery, Odense Universitetshospital, Odense, Denmark
| | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicin, University of Copenhagen, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Marc Gjern Weiss
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
| | - Emilie Karense Lykking
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
| | - Kirstine Lærum Sibilitz
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jan Sørensen
- Healthcare Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland Clinical Research Centre, Dublin, Ireland.,Centre for Health Economics Research (COHERE), National Institute of Public Health, University of Southern Denmark, Odense C, Denmark
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