Key result
Integrated rehabilitation in patients with advanced angina pectoris was associated with a 3-year risk of death of 2.0% among surgical candidates, compared to 6.4% in the matched general population.
Why the study?
Does integrated rehabilitation reduce death rate, need for invasive treatment, and health care expenses in patients with advanced angina pectoris?
Observational (n=168)
No
Does integrated rehabilitation reduce death rate, need for invasive treatment, and health care expenses in patients with advanced angina pectoris?
Absolute Event Rate: 2% vs 6.4%
Integrated rehabilitation may reduce mortality and healthcare costs in patients with advanced angina pectoris, though randomized trials are needed to confirm these observational findings.
May support integrated rehabilitation in advanced angina; leaves open confirmation of mortality benefit in randomized trials.
OBJECTIVES: An evaluation of Integrative Rehabilitation (IR) of patients with angina pectoris with respect to death rate, the need for invasive treatment, and cost effectiveness. DESIGN: A report from a clinical database. Death rates were compared to those of the general Danish population matched for age, gender, and observation period, as well as with data from the literature concerning medical and invasive treatments. SETTING: The treatment was carried out as an ambulatory treatment in a private clinic. SUBJECTS: One hundred and sixty-eight (168) patients with angina pectoris, of whom 103 were candidates for invasive treatment and 65 for whom this had been rejected. INTERVENTIONS: Integrated rehabilitation consists of acupuncture, a self-care program including acupressure, Chinese health philosophy, stress management techniques, and lifestyle adjustments. OUTCOME MEASURES: Death rate from any cause, the need for invasive treatment, and health care expenses. RESULTS: The 3-year accumulated risk of death was 2.0% (95% confidence limits: 0.0%-4.7%) for the 103 candidates for invasive treatment, 6.4% for the general Danish population, 5.4% (4.7%-6.1%), and 8.4% (7.7%-9.1%) for patients who underwent percutaneous transluminal balloon angioplasty and coronary artery bypass grafting, respectively, in New York. For the 65 inoperable patients the risk of death due to heart disease was 7.7% (3.9%-11.5%), compared to 16% (10%-34%) and 25% (18%-36%) for American patients, who were treated with laser revascularization or medication, respectively. Of the 103 candidates for invasive treatment, only 19 (18%) still required surgery. Cost savings over 3 years were US 36,000 dollars and US 22,000 dollars for surgical and nonsurgical patients, respectively. These were mainly achieved by the reduction in the use of invasive treatment and a 95% reduction in in-hospital days. CONCLUSIONS: Integrated rehabilitation was found to be cost effective, and added years to the lives of patients with severe angina pectoris. The results invite further testing in a randomized trial.
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Ballegaard et al. (2004) conducted an observational in Advanced angina pectoris (n=168). Integrated rehabilitation vs. General Danish population and historical cohorts was evaluated on Death rate from any cause, the need for invasive treatment, and health care expenses. Integrated rehabilitation in patients with advanced angina pectoris was associated with a 3-year risk of death of 2.0% among surgical candidates, compared to 6.4% in the matched general population.
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