Shared Care Rehabilitation After Acute Coronary Syndrome

Phase 4

Completed

Conditions: Acute Coronary Syndrome
Myocardial Ischemia
Acute Myocardial Infarction: Rehabilitation Phase

Brief Summary: Cardiac rehabilitation is an individual adapted multidisciplinary intervention for people suffering from Heart Disease. It involves;

* Dietary counseling,

* Exercise training,

* Psychosocial support,

* Physician

* smoking cessation

* Patient education

The purpose is quick and complete recovery and to reduce the chance of recurrence.

In Denmark people admitted with Acute Cardiac Disease is referred to a course of hospital based cardiac rehabilitation at discharge.

The Danish Municipal Reform of 2007 changed the responsibility of rehabilitation from the Regions, who runs the hospitals, to the municipalities.

Shared care is in this setting that elements of treatment are completed different places in Health Care.

The aim of this study is:

* to establish a shared care model for Cardiac rehabilitation following admission with Acute Coronary Syndrome and

* to compare this model to the existing hospital based cardiac rehabilitation after admission with Acute Coronary Syndrome.

Primary outcome is participation in cardiac rehabilitation.

Recruitment & Eligibility

Inclusion Criteria

Admission with Acute Coronary Syndrome
Resident in district of Department of Cardiology, Aarhus University Hospital, Silkeborg or Viborg Hospital, part of the "Hospitalsenheden Midt" Viborg, Silkeborg, Skive, Hammel.
Accept both models of cardiac rehabilitation
written informed consent

Exclusion Criteria

Resident outside the district of Department of Cardiology, Aarhus University Hospital, Viborg Hospital or Silkeborg Hospital, part of "Hospitalsenheden Midt" (Viborg, Silkeborg, Skive, Hammel).
Age 80 years or older
Heart Failure (Ejection Fraction less than 40%)
Severe Comorbidity
Resuscitated and need of support from ergotherapist after discharge.

Arm && Interventions

Group	Intervention	Description
Shared care Model	Shared Care model	* First visit at cardiac ambulatory approximately 14 days after discharge includes examination by cardiologist and counseling from nurse specialized in cardiac rehabilitation. * Dietary counseling with dietician * Exercise (1 hour, 2 timer pr week for 12 weeks) * Smoking cessation if smoker with educated smoking cessation instructor * Patient education and psychosocial support in 2 individual consultations and 8 group based consultations with experienced nurse * Examination by the patient´s general practitioner 8-12 weeks after discharge.

Primary Outcome Measures

Name	Time	Method
Participation in cardiac rehabilitation	4 months	Participation in cardiac rehabilitation is evaluated for each element. Participation is defined as at least 50% for each element. * Smoking cessation * Dietary counseling * Exercise training * Physician * Patient education * Psychosocial support Full participation is in 6 of 6 elements if smoker or 5/5 if non-smoker. Partial full participation is in 5/6 if smoker or 4/5 if non-smoker.

Secondary Outcome Measures

Name	Time	Method
Change of BMI and / or abdominal circumference	4 and 12 months
Blood Cholesterol values (Total, LDL, HDL)	4 and 12 months
Exercise Capacity	4 and 12 months
Lifestyle changes	4 and 12 months	Diet, Physical Activity, Smoking, Alcohol consumption.
24-hour Ambulatory Blood Pressure	4 og 12 months
Difference in Health economic costs	4 and 12 months
Depression score	4 and 12 months	Estimated by Hospital Anxiety and Depression Scale
Fasting Blood glucose	4 and 12 months
Compliance to pharmaceutical treatment	4 and 12 months
Readmission	4 and 12 months	Total and cardiovascular
Change in Health Related Quality of Living	4 and 12 months	SF-12 HeartQoL EQ-5D

Locations (3): Viborg Hospital, Hospital Unit of Viborg, Silkeborg, Hammel and Skive
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Viborg, Denmark
Silkeborg Hospital
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Silkeborg, Region Midt, Denmark
Aarhus University Hospital. Department of Cardiology and Medicine
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Aarhus, Denmark