Key result
Comprehensive cardiac rehabilitation did not significantly improve long-term mortality or ICD shock frequency compared to usual care, but resulted in a reduction in total attributable direct costs by 6,789 USD per patient over 3 years.
Why the study?
Does comprehensive cardiac rehabilitation improve long-term health outcomes and reduce costs in patients with first-time implantable cardioverter defibrillator implantation?
RCT (n=196)
Open-label to staff and patients, blinded outcome assessment
1:1
No
Does comprehensive cardiac rehabilitation improve long-term health outcomes and reduce costs in patients with first-time implantable cardioverter defibrillator implantation?
Comprehensive cardiac rehabilitation in first-time ICD patients significantly reduces total attributable direct healthcare costs over 3 years, despite no significant differences in long-term mortality or ICD therapy.
Answers are grounded in this paper and cite their sources.
Rehabilitation yields no 3-year clinical gains in ICD patients; extends short-term data by showing sustained cost savings.
OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs. METHODS: Patients with first-time implantable cardioverter defibrillator implantation (n = 196) were randomized (1:1) to comprehensive cardiac rehabilitation or usual care. Outcomes were measured by implantable cardioverter defibrillator therapy history from patient records and national register follow-up on mortality, hospital admissions and costs. RESULTS: No significant differences were found after 3 years for implantable cardioverter defibrillator therapy or mortality between rehabilitation and usual care. Time to first admission did not differ. The cost of rehabilitation was 335 USD/276 Euro per patient enrolled in rehabilitation. The total attributable cost of rehabilitation after 3 years was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs.
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Berg et al. (2015) conducted an RCT in First-time implantable cardioverter defibrillator (ICD) implantation (n=196). Comprehensive cardiac rehabilitation vs. Usual care was evaluated on Mortality at 3 years (p=0.19). Comprehensive cardiac rehabilitation did not significantly improve long-term mortality or ICD shock frequency compared to usual care, but resulted in a reduction in total attributable direct costs by 6,789 USD per patient over 3 years.
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