Long-term follow-up after a controlled randomized post-myocardial infarction rehabilitation programme: effects on morbidity and mortality

Abstract

Prognosis during 4.5 years of follow-up after myocardial infarction (MI) in 2 groups of patients 25 to 65 years of age was related to physical rehabilitation and usual risk factors. We randomized 167 patients to a rehabilitation (R) group and a control (C) group (84 and 83 patients respectively). At the end of the training period, the R group had a significantly higher work capacity, a higher double product reached during the stress test and lower triglycerides. During the 55 months of follow-up after the physical training or the equivalent spontaneous activity, we observed the prevalence of risk factors and of cardiac events such as angina, new MI, unstable angina, coronary bypass grafting and cardiac death. Survival rate was 92.6% in the R group and 93.7% in the C group. There was no relationship between serum cholesterol levels, tobacco smoking, and blood pressure and mortality and morbidity after the infarction. R patients were more symptom-free (44% against 30%), and had almost the same number of episodes of unstable angina and of cardiac death. 6.1% of the R group and 11.2% of the C group developed a new myocardial infarction. As in previous randomized studies we did not reach statistical significance for long-term benefit, perhaps because of the low sample size. However, our study confirmed a favorable tendency in terms of symptoms and the self confidence of the R patients.

A prospective study found impaired left ventricular function predicted job retirement after acute myocardial infarction

“…Four years after discharge, 50% of the working-active patients in our study were without a job. Several interventional rehabilitation studies [2][3][4][5][6][7][8][9][10] have failed to show any improvement in the job prognosis. Rehabilitation studies designed to improve the work outcome after MI should be viewed in the light of our study's findings, and should focus mainly on the prognostic factors that we have shown identify high-risk patients with a poorer work outcome after MI.…”

“…Interventional rehabilitation studies, however, have not shown any convincing effect on work outcome [2][3][4][5][6][7][8][9][10]. Rehabilitation programs may not have targeted high-risk groups because of lack of valid data on prognostic factors for retirement.…”

North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of stable angina

“…Five trials elicited no benefit 51 52 53 54 55. All these trials were of different design and used different exercise regimens and durations.…”

Determinants of rehabilitation outcome‐results of follow-up studies of different patient groups with special reference to cardiac patients

“…The measures used have included work status (e.g. Marra, Paolillo, Spadaccini and Angelino, 1985), physical complaints (e.g. Horlick, Cameron, Firor, Bhalerao and Baltzan, 1984), personality dimensions measured with standardized questionnaires (e.g.…”

“…Mallaghan and Pemberton, 1977;Mayou, 1981), readmission to hospital (e.g. Stern, Pascale and Ackerman, 1977;Marra et al, 1985), physiological effects of the exercise program (e.g. Sivarajan, Bruce, Lindskog, Almes, Belanger and Green, 1982), and mortality (e.g.…”