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A EUropean study on effectiveness and sustainability of current Cardiac Rehabilitation programmes in the Elderly

Periodic Reporting for period 3 - EU-CaRE (A EUropean study on effectiveness and sustainability of current Cardiac Rehabilitation programmes in the Elderly)

Reporting period: 2018-05-01 to 2019-04-30

Improving the quality of life (QOL) and independence of elderly heart patients is a major challenge in Europe. Cardiovascular diseases lead, each year, to more than four million deaths in Europe. The disease burden of cardiovascular disease is also a major problem, especially in the elderly. Due to the ageing population, the number of elderly cardiac patients will rise further in the coming decades and exert additional pressure on the healthcare system.

A network of leading heart centres and top research institutes from seven European countries started the EU-CaRE project at May 1st, 2015 to compare, improve and tailor cardiac rehabilitation (CR) programmes for the elderly. EU-CaRE stands for “a EUropean study on effectiveness and sustainability of current Cardiac Rehabilitation programmes in the Elderly” and has as main objective improvement of the QOL and independence of elderly heart patients. It must lead to new guidelines and treatment protocols. In addition, it must put the brakes on the impending explosion of billions of Euros in health care costs for this patient group.
Additionally, a randomised controlled trial (RCT) is conducted in patients who do not volunteer to participate in the conventional CR programme in the observational study, but do volunteer to join a mobile telemonitoring guided programme (mCR). The patients will be randomised in two study arms:
1) join mCR programme for 6 months
2) no mCR programme

General objectives of EU-CaRE:
To compare the effectiveness of currently available CR programmes from 8 European institutes in the elderly (>65 year) population, by collecting relevant data, and analysing and reporting results.
To assess whether mCR as alternative for patients who refuse joining a conventional CR programme is effective to increase participation and adherence of elderly patients in a CR programme, and results in better long-term patient outcomes than the patients who do not follow the mCR programme.
To determine the main preconditions for sustainable effective CR programmes in the elderly, mainly related to lasting improvement of the physical condition, but also related to risk factors, general health (mental health and QOL), and health care utilisation
To analyse the induced and avoided costs and revenues of CR and mCR programmes to determine the cost effectiveness of different approaches
To define the core components for effective recruitment of CR programmes and analyse the impact of mCR on participation grade.
"The most important results from the baseline data of the EU-CaRE observational study have been published (Prescott et al 2019). In this multicentre study the characteristics of 1633 elderly cardiac patients who had been enrolled in a CR programme in seven countries in Europe were described .The manuscripts “Cardiac rehabilitation in the elderly: Results from the European multicentre EU-CaRE comparative study of effectiveness and sustainability of cardiac rehabilitation” and “predictors for one-year effectiveness of cardiac rehabilitation in elderly patient of eight rehabilitation units in Western Europe” have been prepared and ready for submission even as the manuscript “The effect of a mobile telemonitoring guided cardiac rehabilitation programme (mCR) on sustainable changes in VO2peak compared to no cardiac rehabilitation in elderly patients in Europe: The EU-CaRE RCT.” Several abstracts containing results are accepted for presentation at the upcoming 2019 ESC meeting in Paris.

For the EU-CaRE observational study the primary objective of the health economic analysis was to evaluate and to compare the economic impact of CR for elderly heart patients in seven European countries. The manuscript “Comparative cost-effectiveness of cardiac rehabilitation in the elderly across seven European countries” has been prepared and ready for submission.
For the EU-CaRE RCT the primary objective of the health economic evaluation was to compare the cost-effectiveness of mCR and control group in five European countries, including direct costs of the mCR and care utilisation in relation to the effectiveness, measured as change of VO2peak and quality of life. The manuscript “Cost-effectiveness of a mobile telemonitoring guided cardiac rehabilitation programme (mCR) in elderly patients in Europe” is prepared and ready for submission.

One of the main challenges for CR programmes, especially in the elderly, is to improve participation, programme adherence and patient‘s compliance. The variables (social, psychological, motivational and medical) potentially affecting participation are identified.
The manuscripts “Factors associated with non-participation in different cardiac rehabilitation programmes in elderly. EU-CaRE project” and “Participation rate in a tele cardiac rehabilitation programme in elderly: a European comparison” have been prepared and ready for submission.

Compliance and adherence;
The objective was (i) to analyse the differences in compliance and adherence of conventional CR during the study period, (ii) to analyse the incidence of the different causes of dropout in a qualitative way, globally and per centre. Differences between cardiac and medical reasons for dropout and non-medical reasons will be made, (iii) to statistically model the adherence and compliance in order to maximise the continuation of patients to the programme and even ensure that guidelines and changes established would be maintained, so that the benefits of the programme would be really durable.
The manuscripts “Adherence among different cardiac rehabilitation programme in elderly: a European comparison” and “Adherence in a 6-month tele cardiac rehabilitation programme in patients older than 65 years” have been prepared and ready for submission

At the EU-CaRE website ( and other social media; Facebook ( Twitter #EUCaRE #Horizon2020 #CardiacRehabilitation and YouTube EU-CaRE more information can be found regarding latest news and results from the studies."
Regarding CR programmes we can state that “something is better than nothing”. However, to ensure better participation and adherence in this specific elderly (> 65 years old) cardiac patient population across Europe we can state there has to be more attention for tailor-made CR programmes (among which mCR is one of the options). One has to take into account the needs, co-morbidities and physical condition of the specific patient. This approach will also have a positive impact on the sustainable effectiveness and cost-effectiveness which is also of great importance for the future.
The cost of informal care for people with CVD in the EU is important non-health care cost. A better physical condition shall reduce the dependency of help from others. The projected impact will mainly come from the sustainable and cost-effectiveness analysis.
Although the EU-CaRE ends with an advice on improved and/or patient tailored rehabilitation programmes for the elderly patients with CVD, the ultimate long-term exploitation goal is to improve the current European guidelines and/or to develop additional guidelines based on the project’s results.
This will be achieved through collaboration with the ESC and the EACPR, a branch of the ESC. Different nucleus members from the EACPR are participating in the project. EACPR plans to update its position paper on CR in 2020.
EU-CaRE team at Final Project Team meeting
Logo EU-CaRE
Kick off Meeting
The EU-CaRE project as example project metioned by Project Officer of the EU
220th inclusion ISALA EU-CaRE observational
Presentation at EuroPrevent 2018 by WP4 leader Matthias Wilhelm