Factibilidad y resultados de un programa de rehabilitación cardiaca intensiva. Perspectiva del estudio aleatorizado MxM (Más por Menos)

Abstract

Introduccion y objetivos: Los programas de rehabilitacion cardiaca (PRC) engloban intervenciones encaminadas a mejorar el pronostico de la enfermedad cardiovascular influyendo en la condicin fısica, mental y social de los pacientes, pero no se conoce su duracion optima. Nuestro objetivo es comparar los resultados de un PRC estandar frente a otro intensivo mas breve tras un sındrome coronario agudo, mediante el estudio Mas por Menos. Metodos: Diseño prospectivo, aleatorizado, abierto, enmascarado a los evaluadores de eventos y multicentrico (PROBE). Se aleatorizoa los pacientes al PRC estandar de 8 semanas u otro intensivo de 2 semanas con sesiones de refuerzo. Se realizo una visita final 12 meses despues, tras la finalizacion del programa. Se evaluo: adherencia a la dieta, esfera psicologica, habito tabaquico, tratamiento farmacologico, capacidad funcional, calidad de vida, parametros cardiometabolicos y antropometricos, eventos cardiovasculares y mortalidad por cualquier causa durante el seguimiento. Resultados: Se analizoa 497 pacientes (media de edad, 57,8 10,0 an ̃ os; el 87,3% varones; programa intensivo, n = 262; estandar, n = 235). Las caracteristicas basales de ambos grupos eran similares. Al año, mas del 93% habıa mejorado en al menos 1 MET el resultado de la ergometría. Además, la adherencia a la dieta mediterranea y la calidad de vida mejoraron significativamente con el PRC, sin diferencias significativas entre grupos. Los eventos cardiovasculares ocurrieron de manera similar en ambos grupos. Conclusiones: La PRC intensiva podrıa ser tan efectiva como la PRC estándar en lograr la adherencia a las medidas de prevencio n secundaria y ser una alternativa para algunos pacientes y centros.

Introduction and objectives: Cardiac rehabilitation programs (CRP) are a set of interventions to improve the prognosis of cardiovascular disease by influencing patients’ physical, mental, and social conditions. However, there are no studies evaluating the optimal duration of these programs. We aimed to compare the results of a standard vs a brief intensive CRP in patients after ST-segment elevation and non–ST- segment elevation acute coronary syndrome through the Ma ́s por Menos study (More Intensive Cardiac Rehabilitation Programs in Less Time). Methods: In this prospective, randomized, open, evaluator-blind for end-point, and multicenter trial (PROBE design), patients were randomly allocated to either standard 8-week CRP or intensive 2-week CRP with booster sessions. A final visit was performed 12 months later, after completion of the program. We assessed adherence to the Mediterranean diet, psychological status, smoking, drug therapy, functional capacity, quality of life, cardiometabolic and anthropometric parameters, cardiovascular events, and all-cause mortality during follow-up. Results: A total of 497 patients (mean age, 57.8 10.0 years; 87.3% men) were finally assessed (intensive: n = 262; standard: n = 235). Baseline characteristics were similar between the 2 groups. At 12 months, the results of treadmill ergometry improved by 1 MET in 93% of the patients. In addition, adherence to the Mediterranean diet and quality of life were significantly improved by CRP, with no significant differences between the groups. The occurrence of cardiovascular events was similar in the 2 groups. Conclusions: Intensive CRP could be as effective as standard CRP in achieving adherence to recommended secondary prevention measures after acute coronary syndrome and could be an alternative for some patients and centers.