Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial.
OBJECTIVE
To evaluate rehabilitation after myocardial infarction.


METHODS
Randomised controlled trial of rehabilitation in unselected myocardial infarction patients in six centres, baseline data being collected on admission and by structured interview (of patients and spouses) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months.


METHODS
Six district general hospitals.


METHODS
All 2328 eligible patients admitted over two years with confirmed myocardial infarction and discharged home within 28 days.


METHODS
Rehabilitation programmes comprising psychological therapy, counselling, relaxation training, and stress management training over seven weekly group outpatient sessions for patients and spouses.


METHODS
Anxiety, depression, quality of life, morbidity, use of medication, and mortality.


RESULTS
At six months there were no significant differences between rehabilitation patients and controls in reported anxiety (prevalence 33%) or depression (19%). Rehabilitation patients reported a lower frequency of angina (median three versus four episodes a week), medication, and physical activity. At 12 months there were no differences in clinical complications, clinical sequelae, or mortality.


CONCLUSIONS
Rehabilitation programmes based on psychological therapy, counselling, relaxation training, and stress management seem to offer little objective benefit to patients who have experienced myocardial infarction compared with previous reports of smaller trials.
Jones
D A
DA
University of Wales College of Medicine, Llandough Hospital, Cardiff.
West
R R
RR
D000787:Angina Pectoris / Q000188:drug therapy; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000523:psychology / Q000534:rehabilitation*; D005996:Nitroglycerin / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care; D012907:Smoking; D015996:Survival Rate; D016896:Treatment Outcome
D005996:Nitroglycerin