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Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263]

Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263]
Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263]
Background
Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation.
Methods/design
A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting.
Patients
We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation.
Main outcome measures
Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity.
In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence.
Discussion
More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation Uptake Maximisation Study (BRUM) study and has implications for the clinical management of these patients. A novel feature of this study is the inclusion of non-English Punjabi speakers.
cardiac rehabilitation, randomised controlled trial, home care services, coronary disease, economic evaluation
1471-2261
Jolly, Kate
cc422201-8368-47fd-9ef9-cc844cfc0d8d
Lip, Gregory Y.H.
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Sandercock, Josie
464d8d41-521d-479b-a905-e1c6efb270bb
Greenfield, Sheila M.
aabbbf5d-a742-494f-976d-e4415d502721
Raftery, James P.
c7574ea8-5336-4fd2-a689-596c6980103b
Mant, Jonathan
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Taylor, Rod
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Lane, Deirdre
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Lee, Kaeng Wai
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Stevens, A.J.
fab8e88b-0e62-488b-be4f-c8a3cb9988db
Jolly, Kate
cc422201-8368-47fd-9ef9-cc844cfc0d8d
Lip, Gregory Y.H.
0bd5d832-d4c4-42c5-8b6f-0289b3277fe5
Sandercock, Josie
464d8d41-521d-479b-a905-e1c6efb270bb
Greenfield, Sheila M.
aabbbf5d-a742-494f-976d-e4415d502721
Raftery, James P.
c7574ea8-5336-4fd2-a689-596c6980103b
Mant, Jonathan
0d1a0061-0f04-45c7-b20a-15798b1f465c
Taylor, Rod
12fb1379-fab8-4713-9c5d-2662b5b6ca14
Lane, Deirdre
6cc641bc-b200-423c-af3e-86d861942df0
Lee, Kaeng Wai
8cb390c1-966b-47a6-a827-77b69a575526
Stevens, A.J.
fab8e88b-0e62-488b-be4f-c8a3cb9988db

Jolly, Kate, Lip, Gregory Y.H., Sandercock, Josie, Greenfield, Sheila M., Raftery, James P., Mant, Jonathan, Taylor, Rod, Lane, Deirdre, Lee, Kaeng Wai and Stevens, A.J. (2003) Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263]. BMC Cardiovascular Disorders, 3 (10). (doi:10.1186/1471-2261-3-10).

Record type: Article

Abstract

Background
Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation.
Methods/design
A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting.
Patients
We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation.
Main outcome measures
Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity.
In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence.
Discussion
More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation Uptake Maximisation Study (BRUM) study and has implications for the clinical management of these patients. A novel feature of this study is the inclusion of non-English Punjabi speakers.

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More information

Published date: 2003
Keywords: cardiac rehabilitation, randomised controlled trial, home care services, coronary disease, economic evaluation

Identifiers

Local EPrints ID: 24351
URI: http://eprints.soton.ac.uk/id/eprint/24351
ISSN: 1471-2261
PURE UUID: 974a7239-0255-4047-a01f-1b5735aa85f3

Catalogue record

Date deposited: 31 Mar 2006
Last modified: 08 Jan 2022 12:51

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Contributors

Author: Kate Jolly
Author: Gregory Y.H. Lip
Author: Josie Sandercock
Author: Sheila M. Greenfield
Author: James P. Raftery
Author: Jonathan Mant
Author: Rod Taylor
Author: Deirdre Lane
Author: Kaeng Wai Lee
Author: A.J. Stevens

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