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To the Editor We, members of the council of the British Association for Cardiovascular Prevention and Rehabilitation, representing over 800 health professionals, strive to ensure that our guidance for cardiac rehabilitation (CR) programmes is based on best evidence. While, the topic of the RAMIT study 1 is a welcome one, we have significant concerns about this study and feel the authors have made judgements that we do not believe can be supported. Our concerns are outlined within this letter.
First, in the opinion of West et al the evidence for the effect of CR on mortality is out of date. However, the authors did not include the systematic review published last year by the Cochrane Heart Group. 2 The Cochrane review, 2 which included 47 studies with over 10 000 patients, clearly continues to demonstrate that CR reduces death from any cause by 13% and cardiac deaths by 26%. (The West et al study does not report effect on cardiac deaths).
Second, there are substantial omissions from the paper in terms of the study population. The paper purports to follow CONSORT guidelines 3 but it does not. We do not know how many programmes were approached to participate, thus we have no idea how representative the study sample was of CR programmes at that time. Additionally, there are no details about the numbers of participants who were approached and the numbers who refused (rather than did not meet the...