[Are Intensified Secondary Prevention Programmes Effective Interventions to Reduce Disability-Related Early Retirement After Cardiac Rehabilitation?]

Abstract

PURPOSE\nWe aimed to combine follow-up data from 3 randomized controlled studies to evaluate the effectiveness of intensified (telephone-based) secondary prevention programmes on disability-related early retirement.\n\n\nMETHODS\nEach trial (SeKoNa, Sinko and OptiHyp) compared an intensified (telephone-based) secondary prevention concept as an intervention to an untreated control group (standard management). We extracted extensive baseline data on sociodemographic, clinical and diagnostic characteristics on an individual patient level from the original trial data sets. Follow-up analysis is based on routine data of the German Pension Insurance Rhineland (obtained in August 2019). The primary outcome parameters are mortality (all causes), recurrent cardiac events, and employment status three years after rehabilitation. Here we report results regarding disability-related early retirement. Outcome data were pooled with via meta-analysis for individual patient data (Individual Patient Data Meta-Analysis IPD-MA) using classical meta-analytical techniques (one-stage approach using mixed models and 2-stage approach with inverse variance estimation as fixed effects model).\n\n\nRESULTS\nA total of 1058 cardiac rehabilitation patients were included in the analyses. There were no differences between the pooled intervention group (n=499) and the pooled control group (n=559) regarding any baseline parameter at discharge after 3-week cardiac rehabilitation. There are no indications of statistical heterogeneity. In the total sample incident disability-related early retirement rate was 11.8% at 3-year follow-up. Participation in an intensified secondary prevention programme reduced the risk by about 60% compared to the control group (OR: 0.43; 95% CI: 0.36-0.51).\n\n\nCONCLUSION\nThe need for effective rehabilitation programmes is rapidly growing due to the current demographic trend with an increase in ageing working populations. Secondary prevention programmes following 3-week inpatient rehabilitation are an effective tool to sustainably support the prevention of health-related premature reduction in earning capacity pensions and therefore should complement the existing rehabilitation offer. Based on our results we conclude that secondary prevention should be provided long enough (at least one year) and in personal contact.