Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 141 No. 0102 (2011)

Long term effects of comprehensive cardiac rehabilitation in an inpatient and outpatient setting

  • JM Steinacker
  • Y Liu
  • R Muche
  • W Koenig
  • H Hahmann
  • A Imhof
  • C Kropf
  • S Brandstetter
  • B Schweikert
  • R Leidl
  • DH Schiefer
Cite this as:
Swiss Med Wkly. 2011;141:w13141


OBJECTIVES: To compare the long-term effects of comprehensive outpatient versus inpatient rehabilitation with respect to morbidity and mortality, as well as to changes in physical performance and physical activity.

DESIGN: A total of 163 consecutive patients were enrolled for comprehensive cardiac rehabilitation (CCR) following a recent coronary event, to outpatient or inpatient CCR according to treatment preference because randomisation was accepted by only 4 patients. CCR was six hours per day for 4 weeks and consisted of exercise training, education, psychological support, and nutritional and occupational advice. Examinations were before, after and 12 months after CCR. Primary outcome measures were event-free survival with or without interventions, EFS-I or EFS, respectively, 12 months after rehabilitation

RESULTS: Main patient characteristics were distributed equally in the cohorts. Results were adjusted by logistic regression for age, BMI, LV-function, exercise capacity and physical activity before the event. Adjusted EFS, EFS-I , overall survival and other morbidity outcome measures did not differ significantly. During CCR, physical activity was higher in outpatients, but this difference was not maintained in the follow up. Average physical activity was increased 12 month after CR with no difference between groups.

CONCLUSION: Although influenced by patient preference, participation in either inpatient or outpatient CCR led to comparable results in terms of all-cause or cardiac overall survival, event-free survival and other secondary outcome measures like cardiac morbidity, physical performance and increased physical activity.


  1. Boden WE, Shah PK, Gupta V, Ohman EM. Contemporary approach to the diagnosis and management of non-ST-segment elevation acute coronary syndromes. Prog Cardiovasc Dis. 2008;50(5):311–51. DOI:
  2. Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2007;(3):1–62.
  3. Giannuzzi P, Mezzani A, Saner H, Bjornstad H, Fioretti P, Mendes M, et al. Physical activity for primary and secondary prevention. Position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology. Eur J Cardiovasc Prev Rehabil. 2003;10(5):319–27. DOI:
  4. Marchionni N, Fattirolli F, Fumagalli S, Oldridge N, Del LF, Morosi L, et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation. 2003;107(17):2201–6. DOI:
  5. Giannuzzi P, Saner H, Bjornstad H, Fioretti P, Mendes M, Cohen-Solal A, et al. Secondary prevention through cardiac rehabilitation: position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology. Eur Heart J. 2003;24(13):1273–8. DOI:
  6. Karoff M, Held K, Bjarnason-Wehrens B. Cardiac rehabilitation in Germany. Eur J Cardiovasc Prev Rehabil. 2007;14(1):18–27. DOI:
  7. Iseringhausen O, Schott T, Orde vA. The quality of organization in cardiac rehabilitation – a comparison of inpatient and outpatient forms of service delivery. Rehabilitation. 2002;41:130–9. DOI:
  8. Heidrich J, Liese AD, Kalic M, Winter-Enbergs A, Wellmann J, Roeder N, et al. Secondary prevention of coronary heart disease. Results from EuroASPIRE I and II in the region of Munster, Germany. Dtsch Med Wochenschr. 2002;127(13):667–72. DOI:
  9. Bjarnason-Wehrens B, Predel HG, Graf C, Rost R. Ambulatory cardiac phase II rehabilitation – “the Cologne model” – including 3-year-outcome after termination of rehabilitation. Herz. 1999;24(Suppl 1):9–23. DOI:
  10. Unverdorben M, Unverdorben S, Edel K, Degenhardt R, Brusis OA, Vallbracht C. Risk predictors and frequency of cardiovascular symptoms occurring during cardiac rehabilitation programs in phase III-WHO. Clin Res Cardiol. 2007;96(6):383–8. DOI:
  11. Mookadam F, Arthur HM. Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview. Arch Intern Med. 2004;164(14):1514–8. DOI:
  12. Stilgenbauer F, Reißnecker S, Steinacker JM. Heart rate predictions for the training of cardiac patients. Dtsch Z Sportmed. 2003;54(10):295–6.
  13. Muche R, Imhof A. The Comprehensive Cohort Design as alternative to the randomized controlled trial in rehabilitation research: advantages, disadvantages, and implementation in the SARAH study. Rehabilitation. 2003;42:243–9.
  14. Schweikert B, Hahmann H, Steinacker J, Imhof A, Muche R, Koenig W, Liu Y, et al. Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation. Clin Res Cardiol. 2009;79(12):787–95. DOI:
  15. Meisinger C, Löwel H, Heier M, Kandler U, Döring A. Association of sports activities in leisure time and incident myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study. Eur J Cardiovasc Prev Rehabil. 2007;14(6):788–92. DOI:
  16. Hambrecht R, Gielen S, Linke A, Fiehn E, Yu J, Walther C, et al. Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial. JAMA. 2000;283(23):3095–101. DOI:
  17. Heidrich J, Wellmann J, Hense HW, Siebert E, Liese AD, Lowel H, et al. Classical risk factors for myocardial infarction and total mortality in the community – 13-year follow-up of the MONICA Augsburg cohort study. Z Kardiol. 2003;92(6):445–54. DOI:
  18. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116(10):682–92. DOI:
  19. Bjarnason-Wehrens B, Bott D, Benesch L, Bischoff KO, Buran-Kilian B, Gysan D, et al. Long-term results of a three-week intensive cardiac out-patient rehabilitation program in motivated patients with low social status. Clin Res Cardiol. 2007;96(2):77–85. DOI:
  20. Corra U, Giannuzzi P, Adamopoulos S, Bjornstad H, Bjarnason-Weherns B, Cohen-Solal A, et al. Executive summary of the position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology (ESC): core components of cardiac rehabilitation in chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2005;12(4):321–5. DOI:
  21. Pohlen M, Bunzemeier H, Husemann W, Roeder N, Breithardt G, Reinecke H. Risk predictors for adverse outcomes after percutaneous coronary interventions and their related costs. Clin Res Cardiol. 2008;97(7):441–8. DOI:
  22. Shaw K, Gennat H, O'Rourke P, Del MC. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006; 4:CD003817. DOI:
  23. Peytremann-Bridevaux I, Santos-Eggimann B. Health correlates of overweight and obesity in adults aged 50 years and over: results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Swiss Med Wkly. 2008;138(17–18):261–6.
  24. Schunkert H, Moebus S, Hanisch J, Bramlage P, Steinhagen-Thiessen E, Hauner H, et al. The correlation between waist circumference and ESC cardiovascular risk score: data from the German metabolic and cardiovascular risk project (GEMCAS). Clin Res Cardiol. 2008;97(11):827–35. DOI:
  25. Bucksch J, Schlicht W. Is Mortality reduced by Physical Activity in Normal- and Overweight Men and Woman? Dtsch Z Sportmed. 2010;61(3):72–8.