Key result
Phase 2 cardiac rehabilitation with Phase 3 follow-up improved 1-year post-MI risk factor control, increasing target LDL-C (<55 mg/dL) from 10% to 75.4% and reducing smoking from 48.4% to 13.6% (p<0.001).
Why the study?
Cardiac rehabilitation programs improve cardiovascular risk factor control in the first months after myocardial infarction, but control often worsens in subsequent months and years. This study analysed the persistence of risk factor control at the end of Phase 2 and during prolonged Phase 3 follow-up one year after MI.
Does a Phase 2 Cardiac Rehabilitation Program with extended Phase 3 follow-up maintain secondary prevention risk factor goals at one year in patients after myocardial infarction?
Cohort (n=250)
No
Does a Phase 2 Cardiac Rehabilitation Program with extended Phase 3 follow-up maintain secondary prevention risk factor goals at one year in patients after myocardial infarction?
A Phase 2 cardiac rehabilitation program with extended Phase 3 follow-up maintains high rates of secondary prevention goal achievement one year after myocardial infarction, though mild attenuation occurs after Phase 2 completion, underscoring the need for ongoing follow-up and therapy optimization.
CRP sustains smoking cessation at 1 year post-MI; extends evidence that initial risk factor gains endure beyond rehabilitation.
Background Cardiac Rehabilitation Programs (CRP) are highly effective in improving cardiovascular risk factors control in the first months (Phase 2) after myocardial infarction (MI). However, studies have shown that control worsens in subsequent months and years. Purpose We aimed to analyse, in our local post-MI CRP, the persistence of outcomes at the end of Phase 2 and during prolonged follow-up one year after MI (Phase 3). Methods Patients with MI between November 2021 and November 2024 who completed our Phase 2 CRP and at least a one-year follow-up visit in extended Phase 3 follow-up were included in a prospective registry. Before and after Phase 2 and one-year post-MI, we studied the proportion of patients achieving absolute tobacco abstinence, low-density lipoprotein cholesterol (LDL-C) <55mg/dL, ambulatory blood pressure <130/80mmHg, glycated haemoglobin (HbA1c) <7%, weight control (defined as body mass index [BMI] <30), and adherence to exercise training. Results Our cohort comprised 250 patients. The mean age was 62.9±11.16 years, most patients were male (n=203, 81.2%), hypercholesterolemia was the most prevalent cardiovascular risk factor (n=217, 86.8%), and nearly half of patients were smokers (n=121, 48.4%). Prevention goals before and after Phase 2 and one year post-MI were: 1. Smoking habits: n= 121 (48.4%) / n=16 (6.4%) / n=34 (13.6%), p<0.001; 2. Target LDL-C: n=24 (10%) / n=213 (85.2%) / 181 (75.4%), p<0.001; 3. Target blood pressure: n=180 (72%) / n=237 (94.8%) / n=226 (90.4%), p<0.001; 4. Target HbA1c: n=177 (89.4%) / n=228 (93.4%) / n=193 (89.8%), p=0.03; 5. Target BMI: n=68 (27.2%) / n=55 (22%) / n=23 (30.3%), p=0.008; and 6. Physical activity: increase from 1386 [495-2702.25] to 3339 [17637-5832] METS/week before and after Phase 2 (p<0.001); at 1 year, 30.6% of patients remained highly active, 40% moderately active, and 29.4% had sedentary habits. Changes in pharmacological therapy at one-year visit were performed in 43 (17.2%) patients for lipid-lowering therapy, 29 (11.6%) for antihypertensive drugs, 21 (8.4%) for antidiabetic drugs, 19 (7.6%) for smoking cessation drugs, and 122 (48.8%) for prolonged dual antiplatelet therapy. Conclusion A Phase 2 CRP with extended Phase 3 follow-up can achieve good control of secondary prevention goals one year after MI. Worsening of control is observed in the long-term for all goals, although most patients maintained reasonable control. Pharmacological therapy optimization was frequent at 1-year visit, highlighting the importance of long-term follow-up.
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Cardona-Tercero et al. (2026) conducted a cohort in Myocardial infarction (n=250). Phase 2 Cardiac Rehabilitation Program with extended Phase 3 follow-up vs. Baseline (before Phase 2 CRP) was evaluated on Achievement of secondary prevention goals (tobacco abstinence, LDL-C <55 mg/dL, BP <130/80 mmHg, HbA1c <7%, BMI <30, and exercise adherence) at 1 year post-MI (p=<0.001). Phase 2 cardiac rehabilitation with Phase 3 follow-up improved 1-year post-MI risk factor control, increasing target LDL-C (<55 mg/dL) from 10% to 75.4% and reducing smoking from 48.4% to 13.6% (p<0.001).
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