scholarly journals Effects of the patient education strategy ‘Learning and Coping’ in cardiac rehabilitation on readmissions and mortality: a randomized controlled trial (LC-REHAB)

2020 ◽  
Vol 35 (1) ◽  
pp. 74-85
Author(s):  
V Lynggaard ◽  
A D Zwisler ◽  
R S Taylor ◽  
O May ◽  
C V Nielsen
Keyword(s):  
Patient Education ◽  
Length Of Stay ◽  
Cardiac Rehabilitation ◽  
Controlled Trial ◽  
Absolute Number ◽  
Mortality And Morbidity ◽  
Time To Death ◽  
Individual Interviews ◽  
Education Strategy ◽  
And Coping

Abstract We assessed the effects of the patient education strategy ‘Learning and Coping’ (LC) in cardiac rehabilitation (CR) on mortality and readmissions by exploring results from the LC-REHAB trial. In all, 825 patients with ischaemic heart disease or heart failure were randomized to the intervention arm (LC-CR) or the control arm (standard CR) at three hospitals in Denmark. LC-CR was situational and inductive, with experienced patients as co-educators supplemented with two individual interviews. Group-based training and education hours were the same in both arms. Outcomes were time to death or readmission, length of stay and absolute number of deaths or readmissions. No between-arm differences were found in time to death, first readmission, or length of stay. Within 30 days after completion of CR, the absolute number of all-cause readmissions was 117 in the LC arm and 146 in the control arm, adjusted odds ratio 78 (95% CI: 0.61–1.01), P = 0.06. This trend diminished over time. Adding LC strategies to standard CR showed a short term but no significant long-term effect on mortality or readmissions. However, the study was not powered to detect differences in mortality and morbidity. Thus, a risk of overseeing a true effect was present.

scholarly journals Cost–utility analysis of learning and coping versus standard education in cardiac rehabilitation: a randomised controlled trial with 3 years of follow-up

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001184
Author(s):  
Nasrin Tayyari Dehbarez ◽  
Camilla Palmhøj Nielsen ◽  
Bettine Wulff Risør ◽  
Claus Vinther Nielsen ◽  
Vibeke Lynggaard
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Cardiac Rehabilitation ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cost Utility ◽  
Small Sample ◽  
Life Years ◽  
Patients With Heart Failure ◽  
And Coping

ObjectivesTo enhance adherence to cardiac rehabilitation (CR), a patient education programme called ‘learning and coping’ (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost–utility of the LC-programme compared with the standard CR-programme.Methods825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3 years.A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multiple imputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means and bootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectiveness acceptability curves.ResultsNo statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95% CI –3828 to 12 533) or in QALY (–0.006; 95% CI –0.053 to 0.042). At a threshold of 40 000 Euros, the LC-programme was found to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, the probability of cost-effectiveness increased to 91%.ConclusionsWhile the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups of patients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneity due to the small sample size in this subgroup.

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