Information for Managers and Commissioners about the effect of the RAMIT trial on the evidence for Cardiac Rehabilitation
The recent publication of the RAMIT trial has led some to question the value of cardiac rehabilitation (CR).
The evidence base for cardiac rehabilitation, which includes 47 RCTs, remains secure. Even with the widely questioned RAMIT data added the Cochrane meta-analyses (1), the NICE reviews and all other guidance still show that CR reduces both relative mortality and morbidity very significantly. Results from the National Audit of Cardiac Rehabilitation NACR (2) demonstrate improved health behaviours and health related quality of life from UK CR programmes. There is also evidence that CR remains as effective as in previous eras despite recent changes in cardiology procedures (3). All of the current evidence shows that withdrawing CR from patients would put them at substantial added risk of early mortality. Commissioners should ensure that the programmes they are funding meet the NICE (4) recommendations and comply with the BACPR standards (5) for CR. This will ensure that they are implementing evidence-based treatment. In some cases this may require the restructuring of inadequately funded programmes (6).
- Heran BS, Chen JM, Ebrahim S, et al. Exercise based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011;(7):CD001800.
- National Audit of Cardiac Rehabilitation (NACR). Annual Statistical Report. Vol. 5. British Heart Foundation, 2011:6e11. http://www.cardiacrehabilitation.org.uk/nacr/index.htm
- Taylor R. The RAMIT trial: its results in the context of the 2012 Cochrane Review. Heart April 2012 BMJ Heart 2012;98:8:672-673 doi:10.1136/heartjnl-2012-301728
- National Institute for Health and Clinical Excellence (NICE). Secondary Prevention in Primary and Secondary Care for Patients Following a Myocardial Infarction. NICE, 2007:1e34. CG48. http://guidance.nice.org.uk/CG48/NICEGuidance/pdf/
- British Association for Cardiovascular Rehabilitation (2012) BACPR Standards and Core Components (2nd Edition). http://www.bacpr.com/pages/page_box_contents.asp?pageid=791
- Doherty P & Lewin B. The RAMIT trial, a pragmatic RCT of cardiac rehabilitation versus usual care: what does it tell us? Heart 2012;98:8:605-606 doi:10.1136/heartjnl-2012-301728
The British Heart Foundation, the Care Quality Commission, NHS Digital, British Association for Cardiovascular Prevention and Rehabilitation, the Royal College of Physicians, the DOH Heart Team, NHS Improvement, clinicians and patients continue to work together in support of the National Audit of Cardiac Rehabilitation.