Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study.
OBJECTIVE
To investigate the long-term effect of expanded cardiac rehabilitation on a composite end-point, consisting of cardiovascular death, myocardial infarction or readmission for cardiovascular disease, in patients with coronary artery disease.


METHODS
Single-centre prospective randomized controlled trial.


METHODS
University hospital.


METHODS
Two hundred and twenty-four patients with acute myocardial infarction or undergoing coronary artery by-pass grafting.


METHODS
Patients were randomized to expanded cardiac rehabilitation (a one-year stress management programme, increased physical training, staying at a 'patient hotel' for five days after the event, and cooking sessions), or to standard cardiac rehabilitation.


METHODS
Data on cardiovascular death, myocardial infarction, readmission for cardiovascular disease and days at hospital for cardiovascular reasons were obtained from national registries of the Swedish National Board of Health and Welfare.


RESULTS
The primary end-point occurred in 121 patients altogether (54%). The number of cardiovascular events were reduced in the expanded rehabilitation group compared with the standard cardiac rehabilitation (53 patients (47.7%) versus 68 patients (60.2%); hazard ratio 0.69; P =0.049). This was mainly because of a reduction of myocardial infarctions in the expanded rehabilitation group. During the five years 12 patients (10.8%) versus 23 patients (20.3%); hazard ratio 0.47; P =0.047 had a myocardial infarction. Days at hospital for cardiovascular reasons were significantly reduced in patients who received expanded cardiac rehabilitation (median 6 days) compared with standard cardiac rehabilitation (median 10 days; P =0.02).


CONCLUSIONS
Expanded cardiac rehabilitation after acute myocardial infarction or coronary artery bypass grafting reduces cardiovascular morbidity and days at hospital for cardiovascular reasons.
Plüss
Catrine Edström
CE
Karolinska Institute, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden. catrine.edstrom@ds.se
Billing
Ewa
E
Held
Claes
C
Henriksson
Peter
P
Kiessling
Anna
A
Karlsson
Monica Rydell
MR
Wallen
Håkan N
HN
D001026:Coronary Artery Bypass / Q000523:psychology / Q000534:rehabilitation*; D004032:Diet; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology / Q000534:rehabilitation*; D010353:Patient Education as Topic; D010359:Patient Readmission; D011446:Prospective Studies; D012008:Recurrence; D012046:Rehabilitation / Q000379:methods; D013315:Stress, Psychological / Q000209:etiology / Q000628:therapy; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome