Helter et al.

American

cardial distribution and washout of thallium-201. Circulation 1981;64:924-35. 29. Areeda J, Van Train K, Garcia E, et al. Improved analysis of segmental thallium-201 myocardial scintigrams: quantitation of distribution, washout, and redistribution. In: Esser PD, ed. Digital imaging. New York: Society of Nuclear Medicine, 1982:257-69. 30. Tabachnic BG, Fidel1 LS. Using multivariate statistics. New York: Harper & Row, 1983:222-g. 31. Carey D, Lim AD, Modin GW, Cheitlin MD. Comparison of rate-limitedpredischarge andsymptom-limited delayed stress

Cardiac rehabilitation lower rehospitalization

April 1992 Heart Journal

thallium-201 scintiaraphv after myocardial infarction IAbstract]. Circulation‘i989;80(suppl II):308 32. Passamani E. Davis KB. Gillesuie MJ. Killin T. and the CASS Principal Investigators ‘and Their Associates. ‘A randomized trial of coronary artery bypass surgery: survival of patients with a low ejection fraction. N Engl J Med 1985;312:1665-71. 33. Tilkemeier PL, Guiney TE, LaRaia PJ, Boucher CA. Limited prognostic value of predischarge low-level exercise thallium testing after thrombolytic treatment of myocardial infarction. Am J Cardiol 1990:66:1203-7.

participation costs

predicts

The effect of participation in cardiac rehabilitation on medical costs was determined by measuring hospitalization charges for cardiac admissions over a 3-year period in 580 post-coronary event patients (58% after coronary bypass surgery, 42% after myocardial infarction), of whom 230 entered a cardiac rehabilitation program and 350 did not. Baseline left ventricular ejection fraction was similar in entrants and nonentrants (59.9% vs 59.5%). Over the 1 to 4bmonth follow-up period (mean 21 months), per capita hospitalization charges for participants in cardiac rehabilitation were $739 lower than charges for nonparticipants ($1197 f 3911 vs $1936 2 5459, p = 0.022). This was due to both a lower incidence of hospitalizations and lower charges per hospitalization. Inasmuch as groups differed with regard to age, sex, diagnostic category, and smoking status, data were adjusted for these baseline differences by means of analysis of covariance. Rehospitalization charges remained significantly higher in nonparticipants (p = 0.015). Because physician charges were not measured, the cost differential between groups is underestimated. Results of this study show an association between participation in comprehensive cardiac rehabilitation and lowered cardiac rehospitalization costs in the years after an acute coronary event. (AM HEART J 1992;123:916.)

Philip A. Ades, MD, David Huang, MD, and Sheila 0. Weaver, MS. Burlington,

In view of the enormous direct and indirect costs of coronary artery disease in the United States1 it is becoming increasingly important to justify the economic benefits of specific medical therapies. Exercise-based cardiac rehabilitation programs are coming to play an increasingly important role in the care of post-coronary event patients.2 Pooled trials of supervised exercise conditioning programs in post-my-

From the Divisions of Cardiology and Biometry, University of Vermont College of Medicine. Supported by the Vermont Cardiac Rehabilitation Research and Education Fund. Received for publication June 10, 1991; accepted Sept. 16, 1991. Reprint requests: Philip A. Ades, MD, Division of Cardiology, McClure 1, Medical Center Hospital of Vermont, Burlington, VT 05401. 411135348

916

Vt.

ocardial infarction patients have suggested a mortality benefit over a 3-year follow-up period.3-5 Inasmuch as none of the large, controlled trials of postmyocardial infarction exercise have addressed the issue of long-term cost benefits, we investigated the hypothesis that comprehensive cardiac rehabilitation, which includes both an exercise program and a risk factor teaching component, is associated with cardiac hospitalization charges in post-myocardial infarction and post-coronary artery bypass graft patients. METHODS Patient population.

All patients who survived myocardial infarction or coronary bypass graft procedures at the Medical Center Hospital of Vermont from October 1983to January 1987and who lived within 1 hour’s drive from the medical center were interviewed in the hospital and were

Volume Number

123 4, Pari

Cardiac rehabilitation

1

on rehospitalization

cost

917

Table I. Baseline characteristics Entrants

Nonentrants

Characteristics

(n = 230)

(n = 350)

p Value

Left ventricular ejection fraction (n = 495) Age (yd Sex (male) Diagnosis Post infarction Post bypass surgery Smoking status Current smoker Recent quitter Never smoked Prior work status Blue collar White collar Homemaker Other/Unknown Chronic medical problems

60 k 13%

60 + 15%

0.814

53 k to

58 f 10

875

78%

49% 51%

38% 62 C;

14% 42% 44 ‘Tr.

38 4 9 2) 53%

24% 65 PO 5% 6% 40%

47% 31% 12% 10 “C 78$1

Cardiac rehabilitation participation predicts lower rehospitalization costs.

The effect of participation in cardiac rehabilitation on medical costs was determined by measuring hospitalization charges for cardiac admissions over...
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