title: Can high-risk patients after myocardial infarction participate in comprehensive cardiac rehabilitation?
abstract: Patients with large transmural infarctions (MI) and signs of congestive heart failure (CHF) are often excluded from physical training, because of the risk of malignant arrhythmia or cardiac overloading. From a non-selected MI population less than 65 years we enrolled 37 high-risk patients in a two-year comprehensive cardiac rehabilitation programme, including health education, follow-up at a post-MI clinic, and physical training in outpatient groups. The feasibility, effectiveness and safety of the physical training were evaluated: Twenty-one patients joined the physical training and participated with excellent compliance, reaching the preset levels of training. No adverse effects occurred during the 921 training sessions. The high-risk patients were compared with the remaining 228 patients and a subgroup of 86 low-risk patients with regard to mortality, morbidity, medication, effect on risk factors, exercise test performance and rate of return to work. The high-risk group showed a higher mortality (27.0 vs. 10.4%, p less than 0.05), a lower maximal work capacity at the exercise test 4 months after MI (126 W vs. 140 W, p less than 0.05), and a lower rate of early return to work (22.6 vs. 50% p less than 0.01) when compare with the low risk group. However, they showed a similar improvement in exercise test parameters. At the end of the programme a remarkable 63% had returned to work vs. 48.2% of the remaining patients. The reduction in smoking and the effect on blood pressure were equal in both groups. It is concluded that high-risk patients may well benefit from regular physical training in outpatient groups, if adequate medical supervision is available.
authors.affiliation: Department of Internal Medicine, Oskarshamn Hospital, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Hedbäck
authors.forename: J
authors.initials: J
authors.lastname: Perk
mesh_terms: D004651:Employment; D005080:Exercise Test; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000534:rehabilitation*; D010349:Patient Compliance; D012307:Risk Factors