Enhanced cardiac rehabilitation (rehab) programs that include a year of group or personal lifestyle and fitness coaching may not improve cardiovascular risk scores more than a standard three-month program in patients recovering from a myocardial infarction, according to results from the OPTICARE Trial presented Aug. 29 at ESC Congress 2016 in Rome. However, patients who stuck with the year-long program were “happier, healthier and more active,” researchers noted.

The study randomized 914 patients with acute coronary syndrome (ACS) to either standard cardiac rehab (three months/bi-weekly supervises exercise and educational sessions); standard cardiac rehab plus an additional nine months of group sessions on lifestyle and fitness training (CR+G); or standard cardiac rehab plus an additional nine months of personalized telephone lifestyle coaching (CR+T). The primary outcome of the study, measured at 18 months, was the Systematic COronary Risk Evaluation (SCORE) – a 10-year cardiovascular mortality risk score based on systolic blood pressure, total cholesterol and smoking behavior.

In an intention-to-treat analysis, the study found no difference between the groups for the SCORE outcomes. However, the study authors noted that compliance to the enhanced cardiac rehab programs (61 percent (CR+G) and 57 percent (CR+T)) was lower than the standard program (83 percent).

A per-protocol analysis that included only those participants who completed at least 75 percent of their cardiac rehab program, found that among these motivated individuals both smoking cessation and total cholesterol were significantly better in the CR+G  group compared with the standard group (13.4 percent vs. 21.3 percent; P<0.001 and 3.9 vs. 4.3 mmol/L; p<0.001, respectively). Additionally, secondary outcome measures showed that at 18 months, patients in both enhanced cardiac rehab programs had higher health-related quality of life compared to patients in the standard program. CR+G patients were also less anxious.

“Although we were not able to show any greater improvement in metabolic parameters such as cholesterol, blood pressure, BMI, or waist circumference associated with the enhanced protocol overall, there were some initial indications that a firm commitment to a year-long program might encourage more permanent lifestyle improvements,” said lead investigator Ron van Domburg, PhD, from Erasmus Medical Center Rotterdam, the Netherlands.

Keywords: ESC Congress, Behavior Therapy, Myocardial Infarction, Angina, Stable

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