PHASE II CARDIAC REHABILITATION CARRIED OUT ON AN OUT-PATIENTS BASIS IN PATIENTS WITH LOW SOCIAL STATUS

In Germany 98% of Phase II cardiac rehabilitation (CR) is carried out on an in-patient basis. PURPOSE The aim of this study was to examine the effects of out-patients based CR in a larger patient cohort especially in patients with lower socio-economic levels. METHODS The 3 week CR was carried out in 6 CR-centers. Study population: 479 men and 74 women, mean age 56.1 ± 11.9 years. Indications for CR were in 219 cases myocardial infarction (MI), in 92 CAD without MI (84 with an invasive procedure), in 185 coronary artery-bypass-graft, in 55 other cardiac diseases. 70% of the patients were general laborers, 25% had no professional training. RESULTS In 10 cases premature break of CR was observed, in 5 for cardiovascular reasons. Maximal performance increased from 97.8 ± 31.4 to 120.4 ± 37.3 watt (p < 0.001), body-mass-index decreased from 27.1 ± 3.6 to 26.9 ± 3.5 [kg/m-2] (p = 0.010), LDL-cholesterol decreased from 145.9 ± 42.7 to 117.5 ± 34.7 mg% (p < 0.001) and HDL-cholesterol improved from 39.8 ± 11.2 to 41.0 ± 11.3 mg% (p = 0.003). In patients with CAD, we found an increase in beta-blocker therapy (from 75.5% to 76.7%) and in the use of ACE-inhibitors (from 49.5% to 57.0%) and lipid-lowering therapy (from 63.1% to 82.1%). Treatment with anticoagulants or thrombolytics remained high (98.6%). Before CR 53.8% were active cigarette smokers. At CR-end 25.6% were still active smokers with reduced consume (30.0 ± 13.9 to 15.0 ± 14.8 cigarettes/day). DISKUSSION The results obtained are interesting especially with respect to the social status of the patients. The results demonstrate, that rehabilitative measures, which are usually carried out in in-patient settings, can also be implemented, when treating patients on an out-patient basis, without a decrease in the quality of treatment. This also applies to patients who come from lower socio-economic levels. Nevertheless smoking cessation causes severe problems. We attribute this to the lower social status of our cohort and to the fact that these patients were heavily addicted.