Coronary Artery Disease: Oldridge N

Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Anonymous00090. · No affiliation provided · J Cardiopulm Rehabil Prev. · Pubmed #17885506 No free full text.

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Oldridge N. · No affiliation provided · J Cardiopulm Rehabil. · Pubmed #12576909 No free full text.

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Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. · Research and Development Support Unit, Noy Scott House, Haldon View terrace, Exeter, Devon, UK, EX2 5EQ. · Cochrane Database Syst Rev. · Pubmed #11279730 No free full text.

Abstract: BACKGROUND: The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Cardiac rehabilitation aims to restore patients with heart disease to health through exercise only based rehabilitation or comprehensive cardiac rehabilitation. OBJECTIVES: To determine the effectiveness of exercise only or exercise as part of a comprehensive cardiac rehabilitation programme on the mortality, morbidity, health-related quality of life (HRQoL) and modifiable cardiac risk factors of patients with coronary heart disease. SEARCH STRATEGY: Electronic databases were searched for randomised controlled trials, using standardised trial filters, from the earliest date available to December 31st 1998. SELECTION CRITERIA: Men and women of all ages, in hospital or community settings, who have had myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, or who have angina pectoris or coronary artery disease defined by angiography. DATA COLLECTION AND ANALYSIS: Studies were selected independently by two reviewers, and data extracted independently. Authors were contacted where possible to obtain missing information. MAIN RESULTS: This systematic review has allowed analysis of an increased number of patients from approximately 4500 in earlier meta-analyses to 8440 (7683 contributing to the total mortality outcome). The pooled effect estimate for total mortality for the exercise only intervention shows a 27% reduction in all cause mortality (random effects model OR 0.73 (0.54, 0.98)). Comprehensive cardiac rehabilitation reduced all cause mortality, but to a lesser degree (OR 0.87 (0.71, 1.05)). Total cardiac mortality was reduced by 31% (random effects model OR 0.69 (0.51, 0.94)) and 26% (random effects model OR 0.74 (0.57, 0.96)) in the exercise only and comprehensive cardiac rehabilitation groups respectively. Neither intervention had any effect on the occurrence of non-fatal myocardial infarction. There was a significant net reduction in total cholesterol (pooled WMD random effects model -0.57 mmol/l (-0.83, -0.31)) and LDL (pooled WMD random effects model -0.51 mmol/l (-0.82, -0.19) in the comprehensive cardiac rehabilitation group. REVIEWER'S CONCLUSIONS: Exercise-based cardiac rehabilitation is effective in reducing cardiac deaths. It is not clear from this review whether exercise only or a comprehensive cardiac rehabilitation intervention is more beneficial. The population studied in this review is still predominantly male, middle aged and low risk. Identification of the ethnic origin of the participants was seldom reported. It is possible that patients who would have benefited most from the intervention were excluded from the trials on the grounds of age, sex or co-morbidity.

Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. · Research and Development Support Unit, Noy Scott House, Haldon View terrace, Exeter, Devon, UK, EX2 5EQ. · Cochrane Database Syst Rev. · Pubmed #11034729 No free full text.

Abstract: BACKGROUND: The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Circulatory diseases, including myocardial infarction (MI) and stroke, kill more people than any other disease. Cardiac rehabilitation aims to restore patients who have suffered myocardial infarction to optimal health through exercise only based rehabilitation or comprehensive cardiac rehabilitation (eg. smoking cessation advice, diet and counselling as well as exercise). Data from two published and widely cited meta-analyses (Oldridge 1988, O'Connor 1989) of over 4,000 patients each have demonstrated that patients randomised to exercise-based cardiac rehabilitation after MI have a statistically significant reduction in all-cause and cardiac mortality of about 20 to 25% compared to patients receiving conventional care. However, the trials included were small and often of poor methodological quality. Incomplete literature review methods may have resulted in publication bias thereby resulting in an over-estimate of the benefit of cardiac rehabilitation. The randomised controlled trials used in the reviews have focused almost exclusively on low-risk, middle-aged males post MI, thereby excluding women and the elderly. OBJECTIVES: To determine the effectiveness of exercise only rehabilitation and exercise in addition to other rehabilitation interventions (termed comprehensive cardiac rehabilitation) compared with usual care on the mortality, morbidity, health-related quality of life (HRQoL) and modifiable cardiac risk factors of patients with coronary heart disease. SEARCH STRATEGY: Electronic databases were searched for randomised controlled trials, using standardised trial filters, from the earliest date available to December 31st 1998. SELECTION CRITERIA: Men and women of all ages, in both hospital-based and community-based settings, who have had myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, or who have angina pectoris or coronary artery disease defined by angiography have been included. Studies involving participants following heart transplant, heart valve surgery or heart failure have been excluded. Follow up periods of less than 6 months were excluded. DATA COLLECTION AND ANALYSIS: Studies were selected independently by two reviewers, and data extracted independently. Authors were contacted where possible to obtain missing information. MAIN RESULTS: The current systematic review has allowed analysis of an increased number of patients from approximately 4500 in the earlier meta-analyses to 7683 (2582 in exercise only and 5101 in the comprehensive cardiac rehabilitation group). The quality of reporting overall was poor, with generally high losses to follow up. The pooled effect estimate for total mortality for the exercise only intervention shows a 27% reduction in all cause mortality (random effects model OR 0.73 (0.54, 0.98)). Similarly, comprehensive cardiac rehabilitation reduced all cause mortality compared to usual care, but to a lesser degree (OR 0.87 (0.71, 1.05)). Total cardiac mortality was reduced by 31% (random effects model OR 0.69 (0.51, 0.94)) and 26% (random effects model OR 0.74 (0.57, 0.96)) in the exercise only and comprehensive cardiac rehabilitation intervention groups respectively when compared to usual care. Neither intervention had any effect on the ocurrence of non-fatal myocardial infarction. There was a significant net reduction in total cholesterol in the comprehensive cardiac rehabilitation group (pooled WMD random effects model -0.57 mmol/l (-0.83, -0.31)), but not the exercise only rehabilitation group. Similarly, LDL was significantly reduced in the comprehensive cardiac rehabilitation group (pooled WMD random effects model -0.51 mmol/l (-0.82, -0.19). The effect of exercise only rehabilitation or comprehensive cardiac rehabilitation interventions on revascularisation rates, blood pressure or smoking behaviour could not be determined by this meta-analysis due to the small number of trials reporting these outcomes and heterogeneity between trials. It was not possible to combine the data from studies reporting HRQoL as an outcome. Eighteen different instruments were used to assess HRQoL in the 11 studies reporting it as an outcome. The data are presented qualitatively, only one trial reporting significant improvements with the intervention. REVIEWER'S CONCLUSIONS: Exercise-based cardiac rehabilitation appears to be effective in reducing cardiac deaths but the evidence base is weakened by poor quality trials. It is not clear from this review whether exercise only or a comprehensive cardiac rehabilitation intervention is more beneficial. The population studied in this review is still predominately male, middle aged and low risk. Identification of the ethnic origin of the participants was seldom reported. (ABSTRACT TRUNCATED)

Papadakis S, Reid RD, Coyle D, Beaton L, Angus D, Oldridge N. · MINTO Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · Eur J Cardiovasc Prev Rehabil. · Pubmed #18525392 No free full text.

Abstract: BACKGROUND: Little is known about the relative cost-effectiveness of different secondary prevention cardiac rehabilitation (CR) program designs or how cost-effectiveness is influenced by patient clinical and demographic characteristics. The purpose of the study was (i) to evaluate the incremental cost-effectiveness of a standard 3-month CR program (SCR) versus a program distributed over 12 months (distributed CR, DCR); and (ii) to determine the effect of patient demographic characteristics (cardiac risk, cardiac diagnosis, sex) on incremental cost-effectiveness. METHODS: A two group cost-effectiveness analysis was conducted alongside a randomized controlled trial. Patients with coronary artery disease (mean age=58 years, SD+/-10) were randomized to either SCR (n=196) or DCR (n=196) and followed for 24 months. Program delivery costs, cardiac healthcare use, morbidity, mortality, and quality-adjusted life years were assessed. Cost-effectiveness was evaluated with incremental cost-utility analysis. RESULTS: In the pooled analysis, we found the probability of SCR being more cost-effective than DCR was 63-67%. The subanalysis found SCR to be the more cost-effective intervention for patients at high risk, patients with previous coronary artery bypass graft and for male patients. The DCR program was more cost-effective for patients with lower risk of disease progression and for female patients. CONCLUSION: Differences were noted in the cost-effectiveness of CR models based on cardiac risk level, reason for referral, and demographic characteristics. Our results suggest improved cost-effectiveness may be gained by triaging patients to different CR intervention models, however, further investigation is required.

Djelmami-Hani M, Mouanoutoua M, Hashim A, Solis J, Bergen L, Oldridge N, Egbujiobi LC, Allaqaband S, Akhtar M, Bajwa T. · Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wis, USA. · WMJ. · Pubmed #18237072 No free full text.

Abstract: CONTEXT: The American College of Cardiology guidelines consider elective percutaneous coronary intervention (PCI) without on-site surgical backup (OSB) a Class-III indication. OBJECTIVE: Our objective was to determine the safety of elective PCI without OSB. DESIGN: The study is a prospective analysis of a cohort of patients who underwent elective PCI without OSB at our institution. All patients were at our community satellite institution in Beloit, Wis. Three hundred twenty-one elective interventions were performed (mean age 64 +/-12, 68% male). The prevalence of diabetes and hypertension was 28% and 82.5% respectively. INTERVENTION: A predefined protocol was designed to transfer patients to a cardiac surgical facility if necessary. An experienced interventional cardiologist reviewed the diagnostic angiograms. Patients with complex lesions were excluded from the study. MAIN OUTCOME MEASURE: Any procedure-related death or emergency coronary artery bypass graft surgery. RESULTS: Three hundred eighty-two vessels were stented. Multi-vessel intervention was performed in 61 patients (19%). Only 5% of lesions were type C. Four hundred thirty-seven stents were deployed. IIb-IIIa inhibitors were used in 77 (24%) cases. Procedural success was 99.7%. There were no deaths, myocardial infarctions nor need for urgent target vessel revascularization at 6 months. CONCLUSION: With careful patient/lesion selection, an experienced interventional cardiologist and a predefined transfer protocol, elective PCI without OSB can be performed safely.

Höfer S, Doering S, Rumpold G, Oldridge N, Benzer W. · Department of Medical Psychology and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria. · Eur J Cardiovasc Prev Rehabil. · Pubmed #16926670 No free full text.

Abstract: BACKGROUND: Health-related quality of life (HRQL) is increasingly being assessed as an outcome parameter, especially in chronic diseases such as coronary artery disease (CAD), in which the goal of treatment is not only to prolong life but also to relieve symptoms and improve function. DESIGN: This study was carried out as a non-randomized prospective multicentre study. METHODS: Patients (N = 432) with CAD were assessed at baseline, 1 and 3 months after treatment assignment [medication, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)]. HRQL was assessed using the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) and the Short Form 36 (SF-36). Depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale. Routine clinical data including disease severity were collected. RESULTS: The short and intermediate-term results revealed HRQL differences between PCI and CABG in the month immediately after intervention despite the almost identical reduction in angina severity over the first month in both groups. PCI was associated with a relatively rapid increase in HRQL in the first month, with little further change by 3 months. In contrast, after CABG there was an initial deterioration in HRQL, which then improved significantly. The change in depression and anxiety score uniquely accounted for most of the change in the SF-36 (6%, 64%) and MacNew scales (4%, 69%), whereas treatment accounted for less than 1% in any HRQL scale score changes. CONCLUSIONS: There appears to be evidence suggesting that HRQL changes after treatments in patients with CAD may be more strongly influenced by mood disturbance than by treatment methods.

De Gucht V, Van Elderen T, van der Kamp L, Oldridge N. · Department of Clinical and Health Psychology, Faculty of Social Sciences, Leiden University, The Netherlands. · Qual Life Res. · Pubmed #15503843 No free full text.

Abstract: A wide range of instruments have been used in health-related quality of life (HRQL) assessment of patients with coronary artery disease. The MacNew heart disease health-related quality of life questionnaire (MacNew) is a disease-specific measure of HRQL, that has been found to have both good discriminative and evaluative properties. The objective of the present study was to translate the MacNew for a Dutch population, and assess its reliability and validity. Three hundred and thirty-nine cardiac patients, admitted to the hospital after a cardiac event, participated in the study. Questionnaires were filled out at baseline, at 3 months, and at 12 months. A clinically relevant three-factor solution, reflecting an emotional, physical, and social domain of HRQL, allowed us to explain 55% of variance. Angina pectoris was consistently found to be significantly associated with worse HRQL. The pattern of correlations between the subscales of the MacNew on the one hand, and between the subscales of the MacNew and two other, related questionnaires on the other hand, indicated only modest convergent and discriminant validity. The internal consistency was found to be fair to (very) good (ranging between 0.78 and 0.95). Finally, the Dutch MacNew was demonstrated to be substantially more responsive than two other instruments measuring physical and psychological well-being.