Results of the ambulatory cardiac rehabilitation program ("Cologne model")including the results 3 years after termination of the cardiac rehabilitation program

From January 1992 until December 1994 the Cologne model of ambulant cardiac rehabilitation (ACR) in the greater area of Cologne, Germany, was performe d and is still in progress. In Germany until 1992 the cardiac rehabilitatio n was exclusively performed stationary. The objective of the "Cologne model " was to evaluate, whether the transfer of the stationary cardiac rehabilit ation programs into the ambulatory setting is achievable without deficits i n efficiency, safety and overall quality. The results obtained are intended to serve for standardization and quality control of future ambulatory card iac rehabilitation programs in Germany. From 1992 to 1994 108 patients (94 men, 14 women; 52.3 +/- 8.0 years old) w ith coronary artery disease (CAD) which were compatible with the criteria o f the "Cologne model" (Table 1) participated in the 4-week ACR. The indicat ions for inclusion into the ACR were in 74 cases a myocardial infarction (M I), in 34 cases CAD without MI, but with PTCA/stent-procedure (Table 3). Se ven patients discontinued the ACR prematurely, 2 patients because of cardio vascular reasons. Reasons for the preference of the ambulatory over a stati onary cardiac rehabilitation program were in 40.6% of the patients refusal of "hospital ambience", in 43.6% familiar or in 12.9% professional reasons. During the 4-week ACR patients participated in a mean of 72.9 +/- 6.7 hours of therapy (Table 4). As a result of the ACR exercise tolerance increased highly significantly (**) from 116.4 +/- 28.8 to 129.9 +/- 34.6 watt). This improvement was maintained at the 1- and 3-year control (128.7 +/- 35.8**) examinations (Tables 5 and 7). One year after ACR 77% of the patients stat ed to be physically active in ambulatory heart groups (AHG) (27.6%) or on t heir own (49.4%). Three years after ACR the rate of regularly physically ac tive patients still was 59.2%. Furthermore, as a result of ACR the dietary behavior was changed significantly There was a reduction in the consumption of Lipids by 20.8%, saturated fatty acids by 30.7% and of cholesterol by 3 0.5%. The plasma concentrations of cholesterol decreased from 231 +/- 49.8 to 213.2 +/- 35.9 mg%**. Six (and 12) months after ACR they increased again to 225.6 +/- 39.4 mg%. Three years after ACR the mean cholesterol level wa s 219.1 +/- 39.3 mg%. In the high risk group (cholesterol at the initial vi sit > 220 mg%) cholesterol levels were reduced from 266 +/- 44 to 232 +/- 3 1.9 mg%**. Six and 12 months after ACR they were 239.7 +/- 35.8 mg% and 245 .8 +/- 32.6 mg%, respectively, (Tables 6 and 7) and still significantly low er than before ACR, though only 19% of the patients were treated with lipid lowering agents Three years after ACR cholesterol were 234.6 +/- 37.7 mg%* * in the high-risk group. 34.2% of the patients received lipid lowering age nts. Mean body weight remained unaltered over the 3-year period. Smoking be havior was not altered significantly during the 4-week ACR. However, before the cardiovascular event 67.3% of the patients had smoked cigarettes At th e beginning and at the end of ACR 20.8% of the patients still smoked. Durin g the ACR the number of smoked cigarettes was reduced significantly from 32 .4 +/- 15.2 to 6.9 +/- 5.2 cigarettes per day. One year after ACR 23% of th e patients were smokers, 3 years after ACR the percentage of smoke ls incre ased to 30.3%. Before ACR 73.3% of the patients were still working. During the first 6 months after ACR 68.2% returned to work and the percentage incr eased to 73% in the following 6 months The results demonstrate that it is achievable to transfer the contents of t he established stationary cardiac rehabilitation programs into the ambulato ry setting without loss of efficiency, safety and overall quality. It is fu rther confirmed, that it is necessary to continuously evaluate the results of the cardiac rehabilitation program on a long-term basis. This will allow to identify deficits in the existing system of cardiac rehabilitation and the subsequent ambulatory rehabilitation treatment and to work out construc tive strategies for further improvement.