RESULTS
Efficacy of CR
CR is an evidence-based intervention that has been shown to
reduce both morbidity and mortality. Comprehensive multifactorial
rehabilitation and prevention programs have been
shown to slow or partially reduce the progression of coronary
atherosclerosis (3,4). Meta-analyses of studies performed in the
1970s and 1980s revealed a significant reduction in total and
cardiac mortality following participation in CR (5,6). While
the application of these analyses in today’s contemporary care
environment of major advances in patient management and
adjunctive cardioprotective drugs is being questioned, results
from a 2003 meta-analysis (7) based on 48 randomized trials
and over 4000 more recent subjects support the findings of the
earlier systematic reviews. Exercise-based CR, compared with
usual medical care, resulted in reductions in total mortality of
27% (95% CI 0.54 to 0.98) and cardiac mortality of 26% (95%
CI 0.57 to 0.96). Furthermore, a recent randomized controlled
trial of patients with single-vessel disease compared a 12-month
CR program with percutaneous coronary intervention (PCI).
The CR group demonstrated superior event-free survival
(87%) and exercise capacity compared with the PCI group
(70%) (P=0.023). The CR outcomes were also accomplished
at a lower cost than PCI (8).