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UBC Theses and Dissertations

Extensive lifestyle management intervention following cardiac rehabilitation Lear, Scott A.

Abstract

Current management of ischemic heart disease (IHD) includes cardiac rehabilitation programs (CRP)- multi-factorial lifestyle and risk factor management programs that reduce IHD risk, morbidity and mortality. Long-term success of CRP depends upon patient adherence to lifestyle and risk reduction practices. However, many CRP do not include any follow-up. Limited reports describe reduced lifestyle adherence and deterioration of risk factors in patients following CRP. No study has effectively addressed the use of a comprehensive follow-up intervention. This thesis describes a 6-month pilot study and the first year of a four-year follow-up trial of patients with IHD following a CRP. The pilot study provided valuable information that was used in the primary trial. Men and women with history of IHD were recruited into the primary trial and randomized to either a lifestyle management intervention (LMI) or usual care (UC). Participants in the LMI group underwent an intervention that consisted of 6 CRP sessions, 6 telephone follow-up calls and 3 lifestyle and risk factor counselling sessions. The LMI was coordinated by a case manager and focused on patient education, behavioural change and risk factor management. Treatment algorithms, developed from clinical guidelines, were implemented with the help of the participants' family physicians. The UC group was reassessed after one year. The primary outcome was the change in global risk as assessed by the Framingham, PROCAM and Dundee risk scores, with secondary outcomes of changes in lifestyle and risk factors. A total of 302 participants (53 women) were recruited and randomized, 151 each group. After one year, 142 and 136 participants completed the final assessment in the LMI and UC groups, respectively. There were no significant differences in global risk reduction between the two groups. There was a trend toward greater risk reduction in the Framingham and PROCAM scores for the LMI participants. There was also a trend toward more favourable changes in lifestyle and risk factors for the LMI participants. This study demonstrates that a modest intervention such as the LMI is feasible in a large cohort and results in non-significant favourable lifestyle and risk factor changes at one year following completion of CRP.

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