Abstract
Background: Cardiovascular disease (which includes coronary heart disease, strokes and circulatory disorders) is the single highest cause of mortality in Ireland, being responsible for over 40% of all deaths. Coronary heart disease accounts for most of these deaths, being responsible for nearly one quarter of all deaths in this country.
Primary and secondary prevention measures help to prevent and slow down the effects of cardiovascular disease. Cardiac rehabilitation helps patients with established heart disease to recover physically, psychologically and emotionally.
The three principal modifiable risk factors for cardiovascular disease are smoking, raised levels of cholesterol in the blood and raised blood pressure, all of which have a relationship to lifestyle, including diet and physical activity. Evidence suggests that when organised multifactorial programmes are provided cardiac rehabilitation can make a substantial difference reducing mortality by as much as 20% to 25% over 3 years. Phase 3 cardiac rehabilitation programmes combine prescriptive exercise training with coronary risk factor modification in patients with established heart disease. However P3 are traditionally hospital-based programmes in Ireland and uptake rates are only 10–40%. CR programmes in the community would increase participation rates by providing locations more accessible for patients in terms of distance and travelling time.
Design: The study used a comparative retrospective approach to compare a hospital-based cardiac rehabilitation programme and a community-based cardiac rehabilitation programme.
Methods: One hundred and seventy-five patients attended a P3 outpatient 8-week exercise and education comprehensive cardiac rehabilitation programme. One hundred and 40 completed a hospital-based cardiac rehabilitation programme and 35 completed a community-based cardiac rehabilitation programme. Routine clinical data including changes in exercise tolerance, risk factor status and patient satisfaction were evaluated, and the opinions of the cardiac rehabilitation multidisciplinary team were also collected.
Results: Findings of the study were that both hospital and community groups received similar benefits in relation to risk factor education and improvements in exercise tolerance. Participants expressed similar levels of satisfaction with both programmes and the cardiac rehabilitation multi-disciplinary team's evaluation was positive.
Conclusion: These findings show that P3 cardiac rehabilitation programmes may be successfully run in the community as both groups demonstrate similar benefits in terms of exercise tolerance and participant satisfaction. More research is needed to measure the risk factor intervention benefits and costs of a community-based cardiac rehabilitation programme in relation to staffing and resources.