Aneurysm care trial - cardiac rehabilitation after aneurysm repair

ISRCTN ISRCTN65746249
DOI https://doi.org/10.1186/ISRCTN65746249
Secondary identifying numbers 16287
Submission date
05/06/2014
Registration date
05/06/2014
Last edited
30/09/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
An aortic aneurysm is a swelling of the largest blood vessel in the body in the chest or the abdomen. This denotes a weakness that, if allowed to become large enough, puts the patients at risk of the blood vessel bursting. If this happens it is usually fatal so, if at all possible, they are repaired surgically before this occurs. Arterial disease affecting the heart is unusually common in survivors of aortic aneurysm surgery and heart disease is the major cause of death and complications following surgery in these patients. Cardiac rehabilitation (CR) is a structured programme using lifestyle measures, exercise and education, which improves the life expectancy of patients with heart disease and is provided through a well-developed national infrastructure. It is not currently known if survivors of aneurysm repair would have improved long-term survival if enrolled in CR rather than standard care. This small-scale study is aiming to find out how many survivors of aneurysm repair would agree to participate in a study of rehabilitation therapy and to establish their attendance once enrolled.

Who can participate?
Patients who undergo aneurysm repair operation and are discharged from the hospital during the study recruitment period.

What does the study involve?
Patients will first be made aware of the study when they attend clinic appointments prior to surgery, and will be provided with an information leaflet to take away and read - it will be made clear that entry into the programme is not compulsory, but that if they consent adherence to the programme is important. Once the patient has successfully undergone their aortic aneurysm repair and are fit for discharge, they will be asked whether or not they would like to participate in the study. If they agree, they will be randomly allocated to one of two groups: the treatment group or standard care. Those that decline to be included in the study will be asked to complete a short questionnaire to find out the reasoning behind choosing not to take part in such a study (e.g. travelling, lack of understanding etc.). The patients in the standard care group will receive standard surgical follow-up and routine primary care management after surgery. The patients in the treatment group will attend the structured, established cardiac rehabilitation programme. The programme will typically start 4-6 weeks after their surgery and involves attending a session lasting 1-2 hours once a week for 6-8 weeks. However, in instances where it is deemed the patient will benefit from longer in the programme this is extended. Once a week there is an education session run after the exercise class to advise about other lifestyle factors, dietary advice and to give advice about medication (a pharmacist attends this session). We will be conducting a series of additional blood tests to both groups of patients at three points during the study: at the start, after 12 weeks and after 6 months. We will also be taking saliva and urine samples at each of these time points to look for potential kidney disease and adherence to smoking cessation, and also conducting echocardiograms (heart scans) at each time point to assess the functioning of the heart.

What are the possible benefits and risks of participating?
CR is a well-established, safe programme, which is conducted under close supervision. The only burden will be attending the rehabilitation classes. Those who are unable to attend the sessions will be excluded from the study. However, if a larger study were to be deemed possible in the future it is possible provision could be made for them to have rehabilitation at home. There is a risk that patients enrolled in treatment as usual will not receive therapy in line with the national guidelines (NICE) from their GPs. In cases where this is found, we will write to the patient's GP and inform them of the discrepancy with the NICE guidelines. This will ensure that the risk to patients is minimised.

Where is the study run from?
This study is being carried out at two sites in the UK – St George’s Vascular Institute, London (lead centre) and University Hospitals of Leicester.

When is the study starting and how long is it expected to run for?
The study started in April 2014 and runs until October 2015.

Who is funding the study?
British Heart Foundation (BHF), UK.

Who is the main contact?
Mr Peter Holt (Consultant and Senior Lecturer of Vascular Surgery), St George’s Vascular Institute, London
Mr Matt Brown (Consultant Vascular Surgery), Leicester

Contact information

Mr Sandeep Bahia
Scientific

St Georges Hospital
Blackshaw Road
Tooting
London
SW17 0QT
United Kingdom

Email bahia_sandeep@yahoo.co.uk

Study information

Study designRandomised; Interventional; Design type: Prevention, Process of Care, Treatment
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Other
Study typePrevention
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titlePilot randomised controlled trial of cardiac rehabilitation vs standard care after aortic aneurysm repair to reduce adverse cardiovascular events
Study objectivesOur study hypothesis is that at least 60-70% of patients surviving aneurysm repair will agree to trial enrolment into a study of CR after elective aneurysm repair with a true figure of 70-80%. We are also aiming to establish if a minimum of 60-70%, with a true value of 75-90%, of patients will attend all scheduled CR sessions in those randomised to the CR limb of the study.
Ethics approval(s)13/LO/0395; First MREC approval date 21/02/2014
Health condition(s) or problem(s) studiedTopic: Cardiovascular disease; Subtopic: Cardiovascular (all Subtopics); Disease: Cardiovascular
InterventionCardiac Rehabilitation: Patients undergoing elective aortic aneurysm surgery will be randomised. The 'intervention' limb will enter into a cardiac rehabilitation programme surgery.
Care as Usual, Normal post-operative care; this will mean standard surgical follow-up and routine primary care management post surgery.
Follow-up length: 6 month(s); study entry: registration and one or more randomisations
Intervention typeOther
Primary outcome measure1. The number of patients surviving aneurysm repair that agree to enroll in an RCT of rehabilitation vs standard therapy, to establish the proportion of those approached who agree to consent to entry to the CR programme
2. The level of compliance with cardiac rehabilitation (CR) therapy and attendance of the scheduled sessions
Secondary outcome measures1. Time to death
2. Time to first cardiovascular event after aneurysm repair. This is a composite endpoint including non-fatal myocardial infarction, stroke, revascularization and nontraumatic amputation. The revascularization endpoint includes strictly defined procedures (coronary artery bypass graft surgery, percutaneous coronary interventions and percutaneous coronary interventions) and peripheral vascular procedures (embolectomy, bypass and angioplasty). In the absence of relevant COMET outcomes, this outcome measure mirrors the composite cardiovascular endpoint measured for previous randomised RCTs of cardiovascular risk reduction. Statistically adjusted analysis of the total number of events during follow-up will eventually minimise the risk that reporting only a 'composite cardiovascular disease event' endpoint may mask a treatment effect or ignore competing risk; for example, the intervention reducing the risk of one event but increase the risk of another.
3. Intermediate phenotypic markers of cardiovascular risk measured at enrolment, 12 weeks after entry to CR and 6 months after entry to CR: serum lipids (total cholesterol, HDL and LDL), systolic and diastolic blood pressure, HbA1C, BNP, Troponin, hsCRP, Fibrinogen, Homocysteine, urate, eGFR, serum insulin levels, and echocardiographic measure of cardiac function. We will also be testing for urinary microalbuminuria at enrolment, 12 weeks and 6 months.
4. Indicators of patient behavior and lifestyle/biometrics: waist:hip ratio and waist circumference, BMI, ankle-brachial pressure index (ABPI) and toe pressures. Smoking cessation outcomes will include: salivary cotinine, expiratory carbon monoxide, 'prolonged abstinence', and attendance at NHS stop-smoking services.
5. Quality of Life: EQ5D5L questionnaires will be administered at enrolment, 12 weeks after entry to CR and 6 months after entry to CR.
6. Cost-Effectiveness: Mean costs and Quality Adjusted Life Years will be compared on an intention-to-treat basis. The perspective will be the NHS and PSS. The analysis will include hospital re-admissions and pharmaceuticals. Unit cost will be obtained from the published literature.
Overall study start date01/04/2014
Completion date01/10/2015

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participantsPlanned Sample Size: 84; UK Sample Size: 84
Total final enrolment68
Key inclusion criteriaAll patients who undergo elective repair of a thoracic or abdominal aortic aneurysm at St George`s Vascular Institute or Leicester Royal Infirmary and are discharged alive from hospital during the study recruitment period will be eligible for entry
Key exclusion criteria1. Under age 50
2. Unable or unwilling to consent
3. Deemed not medically fit enough for rehab programme by lead CR nurse
4. Unwilling or unable to attend the CR sessions
5. Anyone undergoing expedited or emergent surgical intervention for ruptured or symptomatic aortic aneurysms
Date of first enrolment01/04/2014
Date of final enrolment01/10/2015

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

St Georges Hospital
London
SW17 0QT
United Kingdom

Sponsor information

St George's University of London (UK)
University/education

Cranmer Terrace
London
SW17 0RE
England
United Kingdom

ROR logo "ROR" https://ror.org/040f08y74

Funders

Funder type

Charity

British Heart Foundation (BHF), Grant Codes: PG/13/98/30490
Private sector organisation / Trusts, charities, foundations (both public and private)
Alternative name(s)
the_bhf, The British Heart Foundation, BHF
Location
United Kingdom

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 15/04/2015 Yes No
Basic results 29/09/2019 30/09/2019 No No
HRA research summary 28/06/2023 No No

Additional files

ISRCTN65746249_BasicResults_29Sept19.pdf
uploaded 30/09/2019

Editorial Notes

30/09/2019: The following changes were made to the trial record:
1. The basic results of this trial have been uploaded as an additional file.
2. The total final enrolment was added.
08/11/2018: No publications found, verifying study status with principal investigator.