Social deprivation and poor prognosis after cardiac surgeryBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b721 (Published 02 April 2009) Cite this as: BMJ 2009;338:b721
All rapid responses
Denvir and Zamvar’s editorial rightly emphasises the need to target
cardiac rehabilitation after cardiac surgery for socially deprived
patients(1).The authors cite ‘practical problems of attending’ as a
barrier for the low uptake in poorer patients.
Two recent RCTs compared the Heart Manual, a 6 week, nurse facilitated
home based programme with group based hospital based rehabilitation and
found similar clinical and cost outcomes (2)(3)(4). Through offering
patients a choice of these methods we have been able to meet the Coronary
Heart Disease National Service framework target of 85% of suitable
patients taking part in cardiac rehabilitation, a strategy explicitly
recommended in the latest NICE commissioning guidance(5).
Home delivery of cardiac rehabilitation solves a number of the
practical barriers to attending a hospital programme and may, as the
authors suggest, ameliorate the effects of inequity.
(1)Denvir, M. A. & Zamvar, V. 2009, "Social deprivation and poor
prognosis after cardiac surgery", BMJ, vol. 338, p. b721
(2)Dalal, H. M., Evans, P. H., Campbell, J. L., Taylor, R. S., Watt, A.,
Read, K. L., Mourant, A. J., Wingham, J., Thompson, D. R., & Pereira
Gray, D. J. 2007, "Home-based versus hospital-based rehabilitation after
myocardial infarction: A randomized trial with preference arms--Cornwall
Heart Attack Rehabilitation Management Study (CHARMS)", Int.J Cardiol.,
vol. 119, no. 2, pp. 202-211.
(3)Jolly, K., Lip, G. Y., Taylor, R. S., Raftery, J., Mant, J., Lane, D.,
Greenfield, S., & Stevens, A. 2009, "The Birmingham Rehabilitation
Uptake Maximisation study (BRUM): a randomised controlled trial comparing
home-based with centre-based cardiac rehabilitation", Heart, vol. 95, no.
1, pp. 36-42.
(4)Taylor, R. S., Watt, A., Dalal, H. M., Evans, P. H., Campbell, J. L.,
Read, K. L., Mourant, A. J., Wingham, J., Thompson, D. R., & Pereira,
G. D. 2007, "Home-based cardiac rehabilitation versus hospital-based
rehabilitation: a cost effectiveness analysis", Int.J Cardiol., vol. 119,
no. 2, pp. 196-201.
27 April 2009]
Competing interests: No competing interests