COMPREHENSIVE CARDIAC REHABILITATION PROGRAMME IMPROVES QUALITY OF LIFE AND EXERCISE TOLERANCE IN LOW RISK CARDIAC PATIENTS.

Seng Khiong JONG¹, Daphne Teck Ching LAI², Chee Fui CHONG³, Sok King ONG⁴, Chean Lin CHONG⁵

¹Cardiac Rehabilitation, Occupational Therapy Unit, Raja Isteri Pengiran Anak Saleha Hospital, Negara Brunei Darussalam, ²Department of Computer Science, Faculty of Science, Universiti Brunei Darussalam , Negara Brunei Darussalam, ³Department of Surgery, Raja Isteri Pengiran Anak Saleha Hospital, Negara Brunei Darussalam, ⁴Department of Public Health, Ministry of Health, Negara Brunei Darussalam, ⁴Cardiology Unit, Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Negara Brunei Darussalam

ABSTRACT

Objective: To assess the effect of an outpatient comprehensive cardiac rehabilitation (CCR) programme on cardiac risk factors and quality of life among low risk cardiac patients. Method: Retrospective review of 240 low risk cardiac patients who were enrolled into an eight-weeks CCR programme (Phase II), followed by an 18-months CCR maintenance programme (Phase III) in Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital from 2011 to 2015. Short Form 36 (SF36), exercise test time (ETT), resting systolic and diastolic blood pressure (SBP, DBP), resting heart rate, fasting blood sugar, cholesterol profile (total cholesterol, HDL, LDL, triglyceride), weight, waist circumference (WC) and smoking status were recorded at baseline Phase II enrolment (P1), at the end of Phase II (P2) and Phase III (P3). Results: of the 240 patients enrolled, only 182 patients (75.8% retention rate) completed at least 60% attendance of CCR Phase II programme and entered into CCR Phase III maintenance programme. At the end of Phase III, only 122 patients had complete dataset for analysis. There were statistically significant differences in SF36 scores (71.9±18.4 to 77.3±17.0; p=0.001) and ETT (8.4±2.7 to 9.8±2.9; all P<0.001), Fasting blood sugar (p=0.029), total cholesterol (p=0.001), HDL (p=0.001), LDL (p=0.007), trygliceride (p=0.034) and waist circumference (p=0.026) between all time points (P1-P2-P3). However, these differences on post hoc analysis were attributed to outcome measure improvements which were only seen after completion of Phase II (P2) and were  maintained only in SF36 scores and ETT with significant improvement in HDL levels after Phase III (P3) of the CCR programme. Conclusion: This is the first cardiac rehabilitation efficacy evaluation in Brunei Darussalam. Our study showed that an eight-weeks Phase II CCR programme can significantly improved quality of life measures, exercise test time, biochemical parameters and waist circumference in low risk cardiac patients with sustained improvements in the quality of life measures and exercise tolerance when combine with a 18 months Phase III maintenance programmes. Further implementation of a short supervised period of Phase II in between Phase III may help improve compliance and maintain outcomes.

Key words: Cardiac risk factors, Cardiac rehabilitation, Quality of Life, Percutaneous coronary intervention, myocardial revascularisation.

Correspondence: Seng Khiong JONG, Occupational Therapy Unit, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA 1710, Negara Brunei Darussalam.

HP: +673 8846199       

Email:jong_seng_khiong@yahoo.com; sengkhiong.jong@moh.gov.bn

Brunei Int Med J. 2018;14:17-27