Shared Care Rehabilitation After Acute Coronary Syndrome (SHARED-REHAB)

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.

Acute Coronary Syndrome, Myocardial Ischemia, Shared Care, Rehabilitation, Community, Cardiac Rehabilitation, Hospital

First visit at cardiac ambulatory approximately 14 days after discharge includes physician 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 to 3 individual consultations with nurse specialized in cardiac rehabilitation Examination by cardiologist 8-12 weeks after discharge.

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.

First visit at cardiac ambulatory approximately 14 days after discharge includes physician 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.

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.

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.

Bertelsen JB, Dehbarez NT, Refsgaard J, Kanstrup H, Johnsen SP, Qvist I, Christensen B, Sogaard R, Christensen KL. Shared care versus hospital-based cardiac rehabilitation: a cost-utility analysis based on a randomised controlled trial. Open Heart. 2018 Feb 7;5(1):e000584. doi: 10.1136/openhrt-2016-000584. eCollection 2018.

Bertelsen JB, Refsgaard J, Kanstrup H, Johnsen SP, Qvist I, Christensen B, Christensen KL. Cardiac rehabilitation after acute coronary syndrome comparing adherence and risk factor modification in a community-based shared care model versus hospital-based care in a randomised controlled trial with 12 months of follow-up. Eur J Cardiovasc Nurs. 2017 Apr;16(4):334-343. doi: 10.1177/1474515116666781. Epub 2016 Sep 23.