Find Lower-Cost, Community-based Cardiovascular Risk Reduction Program
Comparable To Formal, Cardiac Rehabilitation Programs
in the June issue of the American Journal of Cardiology concludes that
INTERxVENT, an innovative community-based risk reduction program offered
in the Atlanta area through an affiliation with Emory HealthCare, can
substantially reduce the cost of rehabilitation care for heart attack
patients while achieving similar health benefits as costlier, formal
cardiac rehab programs.
"Cardiac rehabilitation programs
are specifically designed to help people make needed lifestyle changes
and reduce their future risk for heart problems after they have suffered
a heart attack or undergone heart surgery. But as many as 80 percent
of individuals who experience a cardiac event never participate in a
formal cardiac rehabilitation program," says the study's lead author
Neil Gordon, M.D., Ph.D., of the Center for Heart Disease Prevention,
St. Joseph's/Candler Health System in Savannah. "Cost and accessibility
are believed to be two of the most important reasons for the low participation
rates in cardiac rehabilitation programs."
To assess the health results
of several different approaches to cardiac risk reduction programs for
heart patients, Dr. Gordon and his research team, which included scientists
from Stanford University and William Beaumont Hospital in Detroit, Michigan,
followed 155 heart disease patients who had previously suffered a heart
attack or undergone bypass surgery or angioplasty. The research subjects
participated in either a formal cardiac rehabilitation program, a special
program supervised by physicians and administered by nurses, or the
INTERxVENT program (administered primarily by exercise physiologists
working in a shopping mall with a special computer system).
INTERxVENT, which was founded
by Dr. Gordon, is an individualized lifestyle management and cardiovascular
risk reduction program that uses state-of-the-art behavior change techniques
to provide participants with a comprehensive program including exercise,
nutrition, weight management, stress management, and smoking cessation.
Participants communicate with "mentors" either by telephone, the Internet
or during personal counseling sessions and receive individualized advice,
instruction and encouragement to help them meet health goals. Using
the guidelines of national expert groups, such as the American Heart
Association, mentors refer participants to their personal physicians
for medication changes aimed at optimizing cardiovascular disease risk
After 12 weeks, participants
in all three programs derived substantial improvements in multiple cardiovascular
disease risk factors, including blood pressure, cholesterol levels,
weight, and cardiorespiratory fitness. With the exception of cardiorespiratory
fitness, which increased most in the patients in the cardiac rehabilitation
program and the INTERxVENT program, no significant differences were
observed among the three programs.
However, there was a substantial
difference in the cost of the programs. At the time the study was conducted,
the cardiac rehabilitation program charged up to $3,600 for 12 weeks
of participation; the special physician/nurse program was approximately
$410 for 12 weeks of participation; and the INTERxVENT program was $360
for a full year of participation. "This landmark study demonstrates
that the physician/nurse program and, especially, the INTERxVENT program
have the potential to substantially reduce the cost of care for heart
patients while achieving similar benefit," says Dr. Gordon.
He points out that all patients
should be referred to a formal cardiac rehabilitation program after
a heart attack, bypass surgery or angioplasty. "However, if an individual
patient is unable to participate in a formal cardiac rehabilitation
program because it costs too much or they live too far from the program,
our study shows that the physician supervised/nurse case managed program
and the INTERxVENT program are excellent alternatives," says Dr. Gordon.
"Because the INTERxVENT program can be administered in a variety of
medical as well as non-medical settings, it may help reduce costs and
increase accessibility to clinically effective lifestyle management
and cardiovascular disease risk reduction intervention."