Comprehensive cardiac rehabilitation improves outcome for patients with implantable cardioverter defibrillator. Findings from the COPE-ICD randomised clinical trial. (1st February 2015)

• Record Type: Journal Article
• Authors: Berg, Selina Kikkenborg; Pedersen, Preben U; Zwisler, Ann-Dorthe; Winkel, Per; Gluud, Christian; Pedersen, Birthe D; Svendsen, Jesper H
• Is Part Of: European journal of cardiovascular nursing. Volume 14:Number 1(2015)
• Page Start: 34
• Page End: 44
• Publication Date: 2015-02-01
• Subjects: Arrhythmia -- implantable cardioverter defibrillators -- comprehensive cardiac rehabilitation -- exercise training -- psychoeducational intervention; Cardiovascular system -- Diseases -- Nursing -- Periodicals; Cardiovascular Diseases -- nursing -- Periodicals; Cardiology -- Periodicals; Nursing -- Periodicals; Vascular Diseases -- Periodicals; 610.7369105
• DOI: 10.1177/1474515114521920
• Languages: English
• ISSNs: 1474-5151

Abstract

Abstract: Aims: The aim of this randomised clinical trial was to assess a comprehensive cardiac rehabilitation intervention including exercise training and psycho-education vs 'treatment as usual' in patients treated with an implantable cardioverter defibrillator (ICD). Methods: In this study 196 patients with first time ICD implantation (mean age 57.2 (standard deviation (SD)=13.2); 79% men) were randomised (1:1) to comprehensive cardiac rehabilitation vs 'treatment as usual'. Altogether 144 participants completed the 12 month follow-up. The intervention consisted of twelve weeks of exercise training and one year of psycho-educational follow-up focusing on modifiable factors associated with poor outcomes. Two primary outcomes, general health score (Short Form-36 (SF-36)) and peak oxygen uptake (VO2 ), were used. Post-hoc analyses included SF-36 and ICD therapy history. Results: Comprehensive cardiac rehabilitation significantly increased VO2 uptake after exercise training to 23.0 (95% confidence interval (CI) 20.9–22.7) vs 20.8 (95% CI 18.9–22.7) ml/min/kg in the control group ( p =0.004 (multiplicity p =0.015)). Comprehensive cardiac rehabilitation significantly increased general health; at three months (mean 62.8 (95% CI 58.1–67.5) vs 64.4 (95% CI: 59.6–69.2)) points; at six months (mean 66.7 (95% CI 61.5–72.0) vs 61.9 (95% CI 56.1–67.7) points); and 12 months (mean 63.5 (95% CI 57.7–69.3) vs 62.1 (95% CI 56.2–68.0)) points ( p <0.05). Explorative analyses showed a significant difference between groups in favour of the intervention group. No significant difference was seen in ICD therapy history. Conclusion: Comprehensive cardiac rehabilitation combining exercise training and a psycho-educational intervention improves VO2 -uptake and general health. Furthermore, mental health seems improved. No significant difference was found in the number of ICD shocks or anti-tachycardia pacing therapy.