Rehabilitation of the Patient after Myocardial Infarction: The Pivotal Role of the Primary Care Physician

Invalidism is often unnecessarily prolonged after myocardial infarction because of misinformation about the natural history of the illness and because of psychosocial difficulties. To correct these problems, the rehabilitative approach should begin at the onset of illness and remain as a continuing feature in the long-term care of the patient; rehabilitation must thus be the responsibility of the patient's primary physician, who may be a general physician or a practicing cardiologist. Cardiovascular rehabilitation services should be designed to restore the patient, as rapidly as possible, to a productive, active and satisfying life. For patients with significant residual cardiac damage or particular psychological social or vocational problems, conventional medical management is often insufficient to ensure return to a full, active and productive life. The clinician should appreciate this problem early in the course of the illness and institute referral for specialized consultant assessment and management. However, all aspects of the long-term care and rehabilitation of the patient after myocardial infarction must remain under the aegis of the primary physician, ultimately using the personnel, facilities and services of the local community.