Key result
Expanded cardiac rehabilitation shows no 10-year mortality benefit over standard CR in socially vulnerable post-MI patients.
Why the study?
A socially differentiated cardiac rehabilitation intervention showed short-term improvements, but its long-term impact on mortality and non-fatal events in socially vulnerable MI patients was unknown.
Does an expanded socially differentiated cardiac rehabilitation intervention reduce mortality and major cardiac events in socially vulnerable patients with first episode myocardial infarction?
Cohort (n=379)
No
Does an expanded socially differentiated cardiac rehabilitation intervention reduce mortality and major cardiac events in socially vulnerable patients with first episode myocardial infarction?
An expanded cardiac rehabilitation program for socially vulnerable patients with a first myocardial infarction did not improve 10-year mortality or cardiovascular outcomes compared to standard rehabilitation.
Answers are grounded in this paper and cite their sources.
No mortality benefit seen with expanded CR in socially vulnerable first-MI patients; leaves open whether RCTs would show benefit.
OBJECTIVE: Cardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socially differentiated CR intervention and examine the impact of the intervention on all-cause mortality, cardiovascular mortality, non-fatal recurrent events and major cardiac events (MACE) 10 years after. DESIGN: Prospective cohort study. SETTING: The cardiac ward at a university hospital in Denmark from 2000 to 2004. PARTICIPANTS: 379 patients aged <70 years admitted with first episode myocardial infarction (MI). The patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and their social network. A complete follow-up was achieved. INTERVENTION: A socially differentiated CR intervention. The intervention consisted of standard CR and additionally a longer phase II course, more consultations, telephone follow-up and a better handover to phase III CR in the municipal sector, in general practice and in the patient association. MAIN OUTCOME MEASURES: All-cause mortality, cardiovascular mortality, non-fatal recurrent events and MACE. RESULTS: There was no significant difference in all-cause mortality (OR: 1.29, 95% CI 0.58 to 2,89), cardiovascular mortality (OR: 0.80, 95% CI 0.31 to 2.09), non-fatal recurrent events (OR:1.62, 95% CI 0.67 to 3.92) or MACE (OR: 1.31, 95% CI 0.53 to 2.42) measured at 10-year follow-up when comparing the expanded CR intervention to standard CR. CONCLUSIONS: Despite the significant results of the socially differentiated CR intervention at 1-year follow-up, no long-term effects were seen regarding the main outcome measures at 10-year follow-up. Future research should focus on why it is not possible to lower the mortality and morbidity significantly among socially vulnerable patients admitted with first episode MI.
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Hald et al. (2018) conducted a cohort in Myocardial infarction (n=379). Expanded cardiac rehabilitation vs. Standard cardiac rehabilitation was evaluated on All-cause mortality (OR 1.29, 95% CI 0.58-2.89). Expanded cardiac rehabilitation for socially vulnerable patients with first-episode MI did not significantly improve 10-year all-cause mortality compared to standard CR (OR 1.29; 95% CI 0.58-2.89).
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