Impact of multidisciplinarity level of cardiac rehabilitation on cardiovascular disease risk factors in coronary artery disease and congestive heart failure patients.

Abstract

Background: According to clinical guidelines, cardiac rehabilitation programmes should be implemented with a multidisciplinary character. However, it remains to be shown whether such a multidisciplinary approach contributes to greater clinical benefits. The aim of this study was to evaluate the impact of the multidisciplinarity level of cardiac rehabilitation on cardiovascular disease risk factors in coronary artery disease(CAD)and congestive heart failure(CHF)patients. Methods: 450 CAD and CHF patients followed a 3-month multidisciplinary cardiac rehabilitation programme. All subjects performed 2 or 3 exercise training sessions/week, and were advised to follow education sessions (healthy nutrition, cardiovascular pathophysiology and treatment, psychosocial stress coping), a smoking cessation programme(when indicated), dietary counselling(when indicated), and/or psychological consultations(when indicated). Next, with multivariate regression analysis we evaluated whether the participation frequency to these multidisciplinary components (education, dietary and psychological counseling) on top of exercise training sessions affected the change in cardiovascular disease risk factors. Results: As a result of the rehabilitation programme, a significant decrease in body mass index, fasting glycemia level, blood HbA1c content, total and LDL cholesterol level, systolic and diastolic blood pressure, and increase in maximal cycling power output, were noticed (P<0,01). Forty percent, 65%, and 80% of all patients with an indication for social, psychological, and dietary follow-up, respectively, participated in these sessions/programmes. Concering the educational sessions, participation rates varied from 39 percent(dietary information) to 11 percent(relaxation session). The level of multidisciplinarity had a significant, but small, effect on change in blood total cholesterol (P=0,001), LDL cholesterol(P=0,03) content and systolic blood pressure(P<0,05). The other cardiovascular disease risk factors were not influenced by the level of multidiscliplinarity(P>0,05). Conclusions: In this study the degree of multidisciplinarity in cardiac rehabilitation appears to have small effects on the change in cardiovascular disease risk factors.