Effect of Learning and Coping Strategies in Cardiac Rehabilitation - Group Study

Background: It is well known that cardiac rehabilitation has potential to reduce morbidity and mortality, but not all patients complete CR. This LC-REHAB trial aims to compare the effect of a new patient education method called learning and coping strategies to that of standard care.

Design: Randomised controlled trial, 1:1 ratio. Participants: Patients above 18 years newly hospitalised with either ischaemic heart disease or heart failure.

Setting: Three hospital Units in Central Denmark Region. Intervention: Cardiac rehabilitation with addition of learning and coping strategies which include participation of experienced patients as co-educators, clarifuing interviews, and inductive teaching style.

Control arm: Standard care cardiac rehabilitation with a decuctive teaching style.

Outcomes: Adherence to cardiac rehabilitation, morbidity, mortality, risk factors, lifestyle, health related quality of life, return to work.

Coronary heart disease is one the most common cause of death in Denmark and is also a chronic disease that 300,000 people in the country are living with. Cardiac rehabilitation is of great significance for this group of people because of its potential to reduce mortality and morbidity. However, not all patients succeed in changing their lifestyle in a positive and heart healthy direction. Thus, it is a great challenge to develop new methods which can help the patients to maintain a more healthy lifestyle in the long run. A concept for patient education, called learning and coping, has been developed in Norway. It is a health education method based on a high degree of involvement from the participants and on what is important for them. Planning, performance and evaluation happens in close cooperation between the health staff and so-called experienced patients. The course begins and ends with individual clarifying interviews.

The aim of this study is to evaluate the effect of learning and coping strategies in cardiac rehabilitation on adherence, risk factors and lifestyle, morbidity and mortality, health related quality of life and return to work.

The number of participants needed are estimated to 750 ptt.s with datacollection at baseline, just after rehabilitation, 3 months after rehabilitation and 3 years after rehabilitation. It is carried out as an open randomised controlled parallel group study in three hospitals in Hospital Unit West Jutland, Central Denmark Region, where the participants newly hospitalised with either ischemic heart disease or heart failure is randomised to either the intervention group with learning and coping strategies or to the standard group without the strategies. The rehabilitation courses in both groups last for eight weeks and consist of both training and education sessions. The concept of learning and coping is applied to the intervention group by letting 'experienced patients' participate in the education and not using standardised teaching slides. Also clarifying individual interviews are completed before and after the course. The 1:1 randomisation is computer generated and is stratified by hospital unit, diagnosis and gender. All analyses will be performed after the principle of 'intention to treat'.

The primary outcomes are adherence to cardiac rehabilitation, morbidity and mortality, while secondary outcomes are risk factors (blood pressure and lipid profile), lifestyle (body mass index, waist circumference, smoking status, exercise capacity and body compositions measured via DXA-scans) and health related quality of life (SF-12, Health Education Impact Questionnaire and Major Depression Inventory) and return to work (derived from the Danish Register for Evaluation of Marginalisation, (DREAM))

Eligibility Criteria:
Inclusion Criteria:

* patients above 18 years hospitalised with ichemic heart disease or heart failure motivated for completing a rehabilitation course

Exclusion Criteria:

* acute coronary syndrome less than five days before randomisation,
* active peri-, myo- or endocarditis,
* untreated symptomatic valvular disease,
* hypertension with systolic pressure over 200 mmHg and/or diastolic pressure over 110 mmHg,
* other extracardiac disease,
* planned revascularization,
* senile dementia,
* known compliance and former participation in the study.

Exclusion Criteria for outcome on return to work:

* age above 60 years
* recieving public transfer payments related to permanent work incapacity at week of inclusion.