Content » Vol 47, Issue 3

Original report

Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes: Findings from the COPE-ICD randomized controlled trial

Selina Kikkenborg Berg , Ann-Dorthe Zwisler, Mette Bjerrum Koch, Jesper Hastrup Svendsen, Anne Vinggaard Christensen, Preben U. Pedersen, Lau Caspar Thygesen
The Heart Centre, Rigshospitalet, 2100 Copenhagen, Denmark. E-mail:
DOI: 10.2340/16501977-1920


Objective: The Copenhagen Outpatient ProgrammE – implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6–12 months significant differences were found in favour of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs.
Methods: Patients with first-time implantable cardioverter defibrillator implantation (n = 196) were randomized (1:1) to comprehensive cardiac rehabilitation or usual care. Outcomes were measured by implantable cardioverter defibrillator therapy history from patient records and national register follow-up on mortality, hospital admissions and costs.
Results: No significant differences were found after 3 years for implantable cardioverter defibrillator therapy or mortality between rehabilitation and usual care. Time to first admission did not differ. The cost of rehabilitation was 335 USD/276 Euro per patient enrolled in rehabilitation. The total attributable cost of rehabilitation after 3 years was –6,789 USD/–5,593 Euro in favour of rehabilitation.
Conclusion: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs.

Lay Abstract


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