title: Expanded cardiac rehabilitation reduces cardiac events over five years.
abstract: OBJECTIVE
  In people with coronary artery disease, does an expanded cardiac rehabilitation program reduce cardiac deaths, myocardial infarctions, and hospital admissions due to cardiovascular disease?
  
  
  METHODS
  Randomised, controlled trial with intention-to-treat analysis.
  
  
  METHODS
  A University hospital in Sweden.
  
  
  METHODS
  People aged less than 75 years who had had a recent myocardial infarction or coronary artery bypass grafts were eligible to participate. Severe co-morbidities were exclusion criteria. Randomisation of 224 participants allocated 111 to undergo expanded cardiac rehabilitation and 113 to a control group.
  
  
  METHODS
  Both groups received standard cardiac rehabilitation, including physical training, education, group and individual counselling, and support to cease smoking. All participants received appropriate preventive medications. In addition, the intervention group received 20 group sessions of stress management, 3 sessions of cooking and diet counselling by a dietician, and a 5-day stay at a 'patient hotel' with several activities including physical training and information.
  
  
  METHODS
  Although other outcomes were reported at the conclusion of 1-year follow-up, the outcomes at the 5-year follow-up were rates of cardiac events: cardiovascular death, acute myocardial infarction, and readmission to a hospital due to other cardiovascular causes.
  
  
  RESULTS
  All participants were followed up via national registers of health and mortality. During the 5-year follow-up, 53 (48%) participants in the expanded cardiac rehabilitation group and 68 (60%) participants in the control group had a cardiac event (hazard ratio 0.69, 95% CI 0.48 to 0.99). This difference was mainly due to only 12 (11%) participants having non-fatal myocardial infarctions in the treatment group versus 23 (20%) in the control group (hazard ratio 0.47, 95% CI 0.21 to 0.97). The number of hospitalisations and the number of days of hospitalisation were both significantly fewer in the treatment group than in the control group.
  
  
  CONCLUSIONS
  Expanded cardiac rehabilitation after acute myocardial infarction or coronary artery bypass surgery reduces the long-term rate of cardiovascular events by reducing myocardial infarctions and days in hospital for cardiovascular reasons.
authors.affiliation: The George Institute for Global Health, The University of Sydney, Sydney.
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern