Integrating comprehensive cardiac rehabilitation (CCR) programs into clinical practice can be beneficial for patients who have experienced a transient ischemic attack (TIA) or a mild, non-disabling stroke, according to a study published Sept. 22 in Stroke.
“Comprehensive cardiac rehabilitation, which integrates structured lifestyle interventions and medications, reduces morbidity and mortality among cardiac patients. CCR has not typically been used with cerebrovascular populations, despite important commonalities with heart patients.”
As an attempt to understand whether six-month outpatient CCR programs are effective for patients who had experienced a mild stroke, Peter L. Prior, PhD, of the London Health Sciences Centre in London, Ontario, and colleagues enrolled 100 patients who were treated between January 2005 and April 2006. While 100 patients were enrolled, 80 patients completed CCR. All patients experienced either a TIA or a mild, non-disabling stroke within the previous 12 months and had one or more vascular risk factors. Six-month CCR outcomes were used as the primary study endpoint.
“Quantitative modeling has demonstrated that at least 80 percent of recurrent vascular events after an initial stroke/TIA could be prevented through a comprehensive multifactorial strategy, including pharmacological and behavioral interventions,” the authors wrote. “Yet, systematic integration of multiple, structured risk reduction interventions within a single framework are not considered in current cerebrovascular secondary prevention guidelines.”
Prior and colleagues reported that aerobic capacity increased from intake to exit. Additionally, the number of patients who met a functional target of seven or more METs increased significantly, from 35.1 percent to 64.4 percent.
The researchers also reported that total cholesterol, high-density lipoprotein and triglycerides decreased. While LDL-cholesterol decreased 10.3 percent, HDL-cholesterol increased 4.4 percent. Mean fasting blood glucose and mean systolic and diastolic blood pressure did not change during the study. Of 14 subjects who were active smokers at the start of the trial, seven quit by exit. Triglycerides decreased by 23.9 mg/dl.
Prior et al noted that 11 patients were reclassified as low risk during the course of the study. For the 80 patients who attended both intake and exit clinics, one patient experienced two TIAs and two subjects each had one TIA without a hospitalization. Meanwhile, one patient had a carotid stent placement.
No recurrent strokes occurred between CCR intake and exit among the 80 subjects who completed both intake and exit exams.
“We observed favorable, statistically and clinically significant changes in key risk mediating intermediate outcome variables. CCR is a feasible, effective, and safe secondary prevention strategy following TIA/MNDS, and offers a promising model for integrated vascular protection across chronic disease entities,” the authors wrote.
"While a TIA or mild stroke may seem small, in reality these events are crucial warning signs of possible catastrophic stroke or heart attack," Prior said in a statement. "Our study is novel because it shows that cardiac rehabilitation, involving structured programs in exercise, nutrition, smoking cessation and psychological services, is a feasible, potentially effective way for TIA or mild stroke patients to reduce their risk of strokes or heart attacks."
The study was funded by the Ontario Ministry of Health & Long-Term Care through the Stroke Strategy of Ontario.