Key result
Expanded cardiac rehabilitation reduced the composite of cardiovascular death, myocardial infarction, or readmission compared to standard rehabilitation (47.7% vs 60.2%; HR 0.69; P=0.049).
Why the study?
Does expanded cardiac rehabilitation reduce a composite of cardiovascular death, myocardial infarction, or readmission for cardiovascular disease in patients with acute myocardial infarction or undergoing coronary artery bypass grafting?
RCT (n=224)
No
Does expanded cardiac rehabilitation reduce a composite of cardiovascular death, myocardial infarction, or readmission for cardiovascular disease in patients with acute myocardial infarction or undergoing coronary artery bypass grafting?
Hazard Ratio: 0.69
Absolute Event Rate: 47.7% vs 60.2%
p-value: p=0.049
An expanded cardiac rehabilitation program including stress management, increased physical training, and cooking sessions significantly reduces long-term cardiovascular morbidity and hospital days after MI or CABG.
Supports expanded cardiac rehabilitation post-MI or CABG; extends evidence for comprehensive secondary prevention programs.
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. DESIGN: Single-centre prospective randomized controlled trial. SETTING: University hospital. SUBJECTS: Two hundred and twenty-four patients with acute myocardial infarction or undergoing coronary artery by-pass grafting. INTERVENTION: 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. MAIN MEASURES: 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). CONCLUSION: Expanded cardiac rehabilitation after acute myocardial infarction or coronary artery bypass grafting reduces cardiovascular morbidity and days at hospital for cardiovascular reasons.
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Plüss et al. (2010) conducted an RCT in Acute myocardial infarction or coronary artery bypass grafting (n=224). Expanded cardiac rehabilitation vs. Standard cardiac rehabilitation was evaluated on Composite of cardiovascular death, myocardial infarction or readmission for cardiovascular disease (HR 0.69, p=0.049). Expanded cardiac rehabilitation reduced the composite of cardiovascular death, myocardial infarction, or readmission compared to standard rehabilitation (47.7% vs 60.2%; HR 0.69; P=0.049).
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