Guideline-based early rehabilitation after myocardial infarction. A pragmatic randomised controlled trial.
OBJECTIVE
To determine the effectiveness of individualised educational behavioural treatment delivered by cardiac nurses in hospital compared to usual care for patients following acute myocardial infarction.


METHODS
One hundred and fourteen consecutive patients were randomised to receive the intervention or usual care. Outcome assessment was by self-report questionnaire (the Hospital Anxiety and Depression Scale and Dartmouth COOP Health Status), interview at 1 month, and self-report at 3 and 12 months. The primary outcome was improvement in the Dartmouth COOP total score from baseline to 3 months.


RESULTS
Four patients needed to be treated to give an additional patient with improvement in health status at 3 months (number needed to treat [NNT] 4, 95% confidence intervals [CIs] 3 to 12). The intervention group were more confident about returning to activities 1 month after discharge from hospital. Treated patients had fewer further treatment needs.


CONCLUSIONS
An individualised educational behavioural treatment delivered by cardiac nurses in hospital may have substantial benefits. A large-scale pragmatic RCT is needed.
Mayou
Richard A
RA
Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK. richard.mayou@psych.ox.ac.uk
Thompson
David R
DR
Clements
Alison
A
Davies
Crispin H
CH
Goodwin
Sarah J
SJ
Normington
Kathryn
K
Hicks
Nicholas
N
Price
Jonathan
J
D000203:Activities of Daily Living; D002300:Cardiac Care Facilities; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology* / Q000534:rehabilitation*; D009726:Nurses; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales