Outpatient rehabilitation in patients with coronary artery and peripheral arterial occlusive disease

Abstract

Objective: To assess participation rates and outcome in outpatient cardiac rehabilitation (OCR) of patients with peripheral arterial occlusive disease (PAOD).

Design: Prospective cohort study.

Setting: Referral center, ambulatory care.

Participants: All patients undergoing OCR at 2 university hospitals in Switzerland from March 1999 to August 2005.

Intervention: OCR during 3 months.

Main outcome measures: Primary endpoints were workload during bicycle stress test and quality of life (QOL), both at the end of OCR. Secondary endpoints were complications during OCR and termination of OCR.

Results: Of 1508 patients, 99 (7%) had PAOD (27 with Fontaine stage I, 69 with stage II, 3 with stage III). Patients with PAOD were older, had more cardiovascular risk factors, and were more likely to have undergone cardiac bypass grafting than those without PAOD. PAOD patients at OCR entry achieved a lower exercise workload than non-PAOD patients (PAOD patients, 105+/-31W and 69%+/-17% of target vs non-PAOD patients, 125+/-38W and 79%+/-19%; P<.001) but both groups achieved similar gains in exercise capacity at the end of OCR (PAOD patients, 126+/-44W and 82%+/-25% vs non-PAOD patients, 153+/-48W and 98%+/-24%; P<.001). For both groups, QOL was similar at baseline and follow-up, and improved equally in most dimensions. OCR was discontinued more often in patients with PAOD than in those without (18% vs 10%, P=.018). Cardiac and noncardiac complication rates were similar.

Conclusions: Patients with PAOD undergoing OCR have a similar benefit but higher dropout rates than other patients. Thus, PAOD patients should be encouraged to participate in OCR, possibly by creating specifically tailored concepts.