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The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based versus hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence.
DOI 10.1186/ISRCTN72884263
ClinicalTrials.gov identifier
EudraCT number
Public title The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based versus hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence.
Scientific title
Acronym BRUM
Serial number at source HTA 99/32/09
Study hypothesis Aim:
What is the relative effectiveness and cost-effectiveness, taking uptake into account, of home-based versus hospital-based cardiac rehabilitation? What are reasons for non-participation?

To answer these questions we will determine:
1. Whether there are differences at six months and one year following hospital- and home-based rehabilitation in:
1.1. Objective cardiac risk factors
1.2. Patient reported uptake and adherence
1.3. And whether these differ between patient groups (the elderly, women and patients from ethnic minority groups)
2. The relative costs of hospital- and home-based cardiac rehabilitation from both the patients' and NHS perspectives
3. Qualitative insights into the reasons for non-participation in the cardiac rehabilitation programmes
Lay summary
Ethics approval Not provided at time of registration.
Study design Randomised controlled trial
Countries of recruitment United Kingdom
Disease/condition/study domain Cardiovascular diseases: Heart disease
Participants - inclusion criteria Consecutive patients admitted to two acute hospitals in the West-Midlands, serving a multi-ethnic patient catchment, following myocardial infarction (MI) or revascularisation (percutaneous transluminal coronary angioplasty [PTCA]/coronary artery bypass graft [CABG]).
Participants - exclusion criteria Not provided at time of registration.
Anticipated start date 01/10/2001
Anticipated end date 28/02/2006
Status of trial Completed
Patient information material
Target number of participants 650
Interventions Hospital-based versus home-based cardiac rehabilitation programmes provided by specialist cardiac rehabilitation nurses. Both programmes will include exercise, relaxation, education and life-style counselling, with referral for psychological treatments as indicated. The home programme will be based around a patient-held manual (The Heart Manual for MI patients) with home visits and telephone support from the cardiac rehabilitation staff. A manual will be developed for revascularisation patients.
Primary outcome measure(s) Primary outcomes at six months and one year:
1. Cardiac risk factors (serum cholesterol, blood pressure, exercise capacity measured by the shuttle test, psychological status-HADS, smoking cessation)
2. Uptake and patient reported adherence to each programme
3. Patient satisfaction and perceptions of the programmes
4. Quality of life
5. Use of secondary preventive medication
6. Health care utilisation and cardiac events

Costs would be assessed from two perspectives: that of the NHS and socially. NHS costs will be based on resource inputs (time with cardiac nurses, other NHS personnel, travel time, drugs, use of other NHS services) costed up to include labour and overhead costs. Societal costs will extend NHS costs to include costs to patients and to any other relevant agencies (to be decided via patient interviews and costed as for the NHS). If the outcomes differ between the models, a cost-effectiveness evaluation will explore incremental cost-effectiveness using the outcome measures noted above. Otherwise a cost-minimisation analysis is appropriate. In either case, modelling will explore the generalisability of the results by locating the costs in a national context by collecting data from other English rehabilitation programmes by means of a survey. The results will be compared with the range of other CHD interventions, linked to work already in progress (JR's involvement in a national cost effectiveness model funded by DoH).
Secondary outcome measure(s) Not provided at time of registration.
Sources of funding NIHR Health Technology Assessment Programme - HTA (UK)
Trial website
Publications 2003 design and rationale at http://www.ncbi.nlm.nih.gov/pubmed/12964946
2005 recruitment analysis at http://www.ncbi.nlm.nih.gov/pubmed/15904499
2009 results in http://www.ncbi.nlm.nih.gov/pubmed/18332063
Contact name Dr  Kate  Jolly
  Address Department of Public Health & Epidemiology
University of Birmingham
The Public Health Building
  City/town Birmingham
  Zip/Postcode B15 2TT
  Country United Kingdom
  Tel +44 (0)121 414 7552
  Fax +44 (0)121 414 7878
  Email C.B.Jolly@bham.ac.uk
Sponsor Department of Health (UK)
  Address Quarry House
Quarry Hill
  City/town Leeds
  Zip/Postcode LS2 7UE
  Country United Kingdom
  Tel +44 (0)1132 545 843
  Email Sheila.Greener@doh.gsi.gov.uk
  Sponsor website: http://www.dh.gov.uk/en/index.htm
Date applied 25/04/2003
Last edited 26/08/2009
Date ISRCTN assigned 25/04/2003
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