Long-term effects of integrated rehabilitation in patients with advanced angina pectoris

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Ballegaard S, Borg E, Karpatschof B, Nyboe J, Johannessen A. (2004)

Long-term effects of integrated rehabilitation in patients with advanced

angina pectoris: a nonrandomized comparative study. J Altern

Complement Med. Oct;10(5):777-83. Lemchesvej 1, DK 2900 Hellerup,

Denmark. 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: 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 AP, 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

and US $22,000 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. PMID: 15650466 [PubMed - in

process]

 

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