Transdiciplinary Approach to the Follow-Up of Patients After Myocardial Infarction

Abstract

Costa e Silva R, Pellanda L, Portal V, Maciel P, Furquim A, Schaan B. Transdiciplinary approach to the follow-up of patients after myocardial infarction. Clinics. 2008;63:489-96. OBJECTIVES:To compare conventional and transdisciplinary care in a tertiary outpatient clinic for patients after their first acute myocardial infarction. METHODS: One hundred fifty-three patients with acute myocardial infarction were randomized at hospital discharge and followedup to compare conventional (n=75) and transdisciplinary care (n=78). They were submitted to a clinical evaluation, received a dietary plan, and were re-evaluated twice in 60-180 days by a nurse, dietitian and physician, when new clinical and laboratory data were collected. The primary outcome was clinical improvement, as evaluated by an index including reduction of body weight, lowering of blood pressure, smoking cessation, increase in physical activity and compliance with medication. RESULTS: The groups were similar at baseline: 63.4% were men, 89.9% had an acute myocardial infarction with ST-segmentelevation, 32.7% were diabetic, and 72.2% were hypertensive. The clinical improvement index was similar between the studied groups: in 33.3 % (transdisciplinary care) vs. 30.4 % (conventional care) of patients, the improvement was very good (P=1.000). Rates of re-hospitalization and death (p=0.127) were similar between transdisciplinary and conventional care. Compliance with diet was higher for transdisciplinary care (50.0%) vs. conventional care (26.1%) (p=0.007), as was compliance with visits (73.3 vs. 40.3%, respectively, p<0.001). CONCLUSIONS: Compliance with diet and visits was higher for transdisciplinary care vs. conventional care; however, the transdisciplinary approach did not provide more clinical benefits than the conventional approach after patients' first acute myocardial infarction in this setting.

The Role of Invasive Therapies in Elderly Patients with Acute Myocardial Infarction

“…Moreover, a transdisciplinary approach to the follow-up could improve the general results. 27 However, since this approach is widely utilized, even in randomized trials, 28 we believe that this fact did not confound our results.…”