A feasibility study evaluating if the cardiac model of rehabilitation is more effective than standard care in reducing cerebrovascular risk factors post Transient Ischaemic Attack

Abstract

Background: Atherosclerosis is the leading cause of death in the UK and is the most common cause of stroke, TIA and heart attack. Most of the risk factors for atherosclerosis are shared by both stroke and cardiac patients and are linked to lifestyle factors such as diet, exercise and smoking.

Addressing lifestyle factors plays an important role in secondary prevention, and patients with heart disease who undertake cardiac rehabilitation programs involving exercise and education sessions, can reduce the risk of cardiac mortality by 26% (Joliffe 2001). The widespread availability of cardiac rehabilitation programs contrasts with the limited lifestyle support available for stroke patients, with only 37% of patients receiving verbal advice from their doctor (Rudd 2004).

Aims: To investigate the feasibity of conducting a randomised controlled trial requiring TIA and minor stroke patients to participate in a standard NHS cardiac rehabilitation programme. The trial will also evaluate the suitability of outcome measures for assessing if the intervention will significantly reduce the risk of secondary cardiovsacular events more effectively than standard care.

Methods: A single blinded randomized controlled feasibility trial was conducted with patients randomised to standard care or standard care and cardiac rehabilitation. Baseline measurements were taken one month post event with end point data collection six months post event.

Results: Twenty four patients (18 TIA, 6 minor stroke) completed the trial and provide evidence that it is feasible for stroke patients to undertake a programme of cardiac rehabilitation the effect of which can be assessed with a battery of risk factor and quality of life measures. Group analysis showed a significantly greater reduction in the primary outcome measure of Cardiovascular Disease (CVD) risk score for subjects in the intervention group in relation to standard care(intervention 25.7 ± 22.8 to 23.15 ± 18.3, control 25.03 ±15.4 to 27.12 ± 16.1, t=-1.81, P<0.05). There were also significant improvements for the intervention group in activity levels and aspects of health related quality of life.

Conclusion: Current secondary prevention strategies for stroke patients are reliant upon pharmacological therapies for managing a lifestyle related disease. This is the first trial to suggest that existing NHS lifestyle modification programmes are an effective and feasible means of reducing the risk of future cardiovascular events.

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Identifiers

ORCID for Joy Conway: orcid.org/0000-0001-6464-1526

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