Development, implementation and audit of a cardiac prevention and rehabilitation programme for patients with coronary artery disease

Objective To establish a comprehensive multi-disciplinary cardiac prevention and rehabilitation programme for patients with coronary artery disease which is reproducible and transferable to other institutions, in order to achieve lifestyle modification, risk factor control and optimal use of proven cardioprotective medication. Design A descriptive study. Setting A hospital based 12 week out-patient programme. Interventions A multi-professional family based programme of lifestyle and risk factor modification was offered to patients presenting with new onset angina and unstable angina, following acute myocardial infarction or after coronary artery bypass surgery. Main outcome measures Non smoking status, body mass index (BMI), blood pressure, cholesterol, and use of prophylactic drug therapies. Patients were assessed at the beginning and at completion of the programme (re-screening) and also 1 year after completing the programme. Results Of 537 patients eligible for the programme, 443 (83%) were recruited, of whom 404 could potentially have completed the programme at the time of this analysis. Of these 308 (76%) participated and 215 (53%) completed the programme. 92% were non-smokers at the end of the programme (86% at 1 year). Mean BMI on completion of the programme was 27.2kg/m(2) (SD 4.3) which was maintained at 1 year (mean 27.0 SD 4.1). 76% of patients achieved their BP target (140/85 for non-diabetics, 130/80 for diabetics) on completion of the programme. This fell to 53% at 1 year, but absolute systolic BP changed only from a mean of 125 mmHg (SD 17) on completion to 135mmHg (SD 18) at 1 year. 87% achieved a fasting total cholesterol <5.0 mmol/l at re-screening (78% at 1 year). 95% of participants were taking antiplatelet therapy on completion of the programme (94% at 1 year). Conclusions A multi-disciplinary cardiac prevention programme can achieve and sustain effective secondary prevention. The principles of this programme are transferable to other institutions. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.