Transdisciplinary approach to the follow-up of patients after myocardial infarction.
OBJECTIVE
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 followed-up 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-segment-elevation, 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.
Costa e Silva
Rosana
R
Institute of Cardiology of Rio Grande do Sul/Fundação Universitária de Cardiologia, Rio Grande do Sul, RS, Brazil.
Pellanda
Lucia
L
Portal
Vera
V
Maciel
Patricia
P
Furquim
Aline
A
Schaan
Beatriz
B
D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D009203:Myocardial Infarction / Q000178:diet therapy / Q000628:therapy*; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D016896:Treatment Outcome