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OPTICARE: Enhanced cardiac rehabilitation program improves quality of life, but not CV risk score
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Patients recovering from MI who participated in enhanced cardiac rehabilitation programs for at least 1 year showed an improved quality of life compared with those in a standard program, according to findings from the OPTICARE trial presented at the European Society of Cardiology Congress.
However, participation in the enhanced program did not result in significant improvement in a risk score measuring CV mortality risk.
“Although we were not able to show any greater improvement in metabolic parameters such as cholesterol, BP, BMI, or waist circumference associated with the enhanced protocol overall, there were some initial indications that a firm commitment to a year-long program might encourage more permanent lifestyle improvements,” presenter Ron van Domburg, PhD, from Erasmus Medical Center, Rotterdam, Netherlands, said in a press release, noting that patients in the enhanced program were “happier, healthier and more active.”
Ron van Domburg
Van Domburg and colleagues randomly assigned 914 patients with ACS to three different cardiac rehabilitation programs:
- The standard program of bi-weekly supervised exercise and educational sessions over the span of 3 months;
- The standard program plus an additional 9 months of lifestyle and fitness training group sessions;
- The standard program with an additional 9-month personal telephone lifestyle coaching system.
The primary outcome was the Systematic Coronary Risk Evaluation Score (SCORE), a 10-year CV mortality risk scored based on modifiable risk factors including systolic BP, total cholesterol and smoking behavior, at 18 months.
The intention-to-treat analysis showed no difference between the groups for SCORE at 18 months, according to the researchers.
However, in a per-protocol analysis of patients who completed at least 75% of their program, smoking cessation was better in the fitness-training group compared with the standard group (smoking rates, 13.4% vs. 21.3%; P < .001), as was total cholesterol (3.9 mmol/L vs. 4.3 mmol/L; P < .001), the researchers reported.
Patients in both enhanced programs had a higher quality of life at 18 months compared with patients assigned to the standard program (P = .004 for fitness-training group vs. standard group; P = .04 for telephone group vs. standard group).
The fitness-training group walked more steps per day compared with the standard group (7,282 vs. 6,679), but “this was not translated into lower [BP] or lower BMI,” van Domburg said.
“Adaptation of a healthy lifestyle is important, since this can directly impact [CV] mortality and several chronic diseases, and we think that perhaps a longer [cardiac rehabilitation] program may help to solidify these types of changes in [patients with MI],” van Domburg said in the release. – by Dave Quaile
Reference:
Van Domburg RT, et al. Hot Line: Prevention and lipids. Presented at: European Society of Cardiology Congress; Aug. 27-31, 2016; Rome.
Disclosure: van Domburg reports no relevant financial disclosures.
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Leslie Cho, MD
This is an important study looking at extended cardiac rehab and whether it can improve patient outcomes. The design is rather complicated. In the intention-to-treat analysis, there was no difference in outcome; however, patients that completed the extended cardiac rehab (more face-to-face time as well as telephone monitoring) appear to smoke less, have better cholesterol control, etc.
Because it is a small study, it cannot answer the important question of whether extended rehab can lower cardiac events. The study would need to be much larger in order answer this. In the small group that was studied, there was no difference between the extended arm vs. the regular treatment arm.
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