- Design
- 12-month follow-up analysis of a randomised controlled trial, Kaplan-Meier and log-rank
- Population
- older adults with ischaemic heart disease randomised to three months of mobile health cardiac rehabilitation or usual care
- Primary outcome
- time to first all-cause hospital readmission over 12 months
- Effect
- no significant difference between groups (log-rank P=0.26)
The RESILIENT trial randomised older adults with ischaemic heart disease to three months of mobile health cardiac rehabilitation or usual care. This analysis reports time to first all-cause hospital readmission over 12 months.
There was no significant difference between the groups (log-rank P=0.26).
That is the whole reported finding, and it is worth a short section rather than a long one. Readmission was not the trial's primary endpoint and a three-month intervention producing no detectable effect on all-cause readmission nine months after it ended is not surprising - all-cause readmission in older adults with ischaemic heart disease is driven by comorbidity, frailty and social circumstance far more than by a rehabilitation programme. The useful conclusion is about what to promise rather than what to do: mobile cardiac rehabilitation may well improve function and confidence, which is why patients are offered it, but it should not be sold to a hospital administrator, or to a patient, as a way of staying out of hospital.
- Do not justify a mobile cardiac rehabilitation programme on readmission reduction
- Continue to offer cardiac rehabilitation for its functional and symptomatic benefits, which this analysis does not address
- Treat all-cause readmission as a blunt endpoint in this population - most of it is not cardiac
- Where a three-month programme ends, ask what maintains the gain for the following nine months
- Note this is a secondary outcome reported briefly; the trial's primary results sit elsewhere
Why it matters
It separates what cardiac rehabilitation is worth offering for from what it is often promised to deliver.
Don't overread it
A briefly reported secondary analysis with a P value only - it does not evaluate the functional benefits for which cardiac rehabilitation is offered.
The statistics, in plain English
A log-rank P of 0.26 with no hazard ratio or confidence interval reported tells you the survival curves did not separate significantly and nothing about how large a difference has been excluded. All-cause readmission is also a noisy endpoint: it includes admissions for falls, infections and social breakdown, so a genuine cardiac benefit could easily be invisible within it.
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