Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials.

Randomized clinical trials of cardiac rehabilitation following myocardial infarction have typically demonstrated a lower mortality in treated patients, but with a statistically significant reduction in only one trial. To overcome the problem of not being able to detect small but clinically important benefits in mortality in randomized clinical trials of exercise and risk factor rehabilitation after myocardial infarction with small numbers of patients, we carried out a meta-analysis on the combined results of ten randomized clinical trials that included 4347 patients (control, 2145 patients; rehabilitation, 2202 patients). The pooled odds ratios of 0.76 (95% confidence intervals, 0.63 to 0.92) for all-cause death and of 0.75 (95% confidence intervals, 0.62 to 0.93) for cardiovascular death were significantly lower in the rehabilitation group than in the control group, with no significant difference for nonfatal recurrent myocardial infarction. These results suggest that, for appropriately selected patients, comprehensive cardiac rehabilitation has a beneficial effect on mortality but not on nonfatal recurrent myocardial infarction.

[1]  A. Folsom,et al.  Improvement in long-term survival among patients hospitalized with acute myocardial infarction, 1970 to 1980. The Minnesota Heart Survey. , 1987, The New England journal of medicine.

[2]  R Peto,et al.  Why do we need systematic overviews of randomized trials? , 1987, Statistics in medicine.

[3]  D L Demets,et al.  Methods for combining randomized clinical trials: strengths and limitations. , 1987, Statistics in medicine.

[4]  B. Hedbäck,et al.  5-year results of a comprehensive rehabilitation programme after myocardial infarction. , 1987, European heart journal.

[5]  T. Chalmers,et al.  Meta-analyses of randomized controlled trials. , 1987, The New England journal of medicine.

[6]  C. G. Blomqvist,et al.  Identification and treatment of low-risk patients after acute myocardial infarction and coronary-artery bypass graft surgery. , 1986, New England Journal of Medicine.

[7]  S. Marra,et al.  Long-term follow-up after a controlled randomized post-myocardial infarction rehabilitation programme: effects on morbidity and mortality. , 1985, European heart journal.

[8]  S. Johansson,et al.  Recurrent myocardial infarction. 1. Natural history of fatal and non-fatal events. , 1985, European heart journal.

[9]  R. Peto,et al.  Beta blockade during and after myocardial infarction: an overview of the randomized trials. , 1985, Progress in cardiovascular diseases.

[10]  M. Petch.  Rehabilitation and comprehensive secondary prevention after acute myocardial infarction: WHO, Copenhagen, 1983; 110 pp.; SwFr 8.00; ISBN 92 890 12501 , 1984 .

[11]  J. Naughton.  Contributions of exercise clinical trials to cardiac rehabilitation. , 1984, Clinics in sports medicine.

[12]  J. Fleiss,et al.  Risk stratification and survival after myocardial infarction. , 1983, The New England journal of medicine.

[13]  E. Gilpin,et al.  Periods of differing mortality distribution during the first year after acute myocardial infarction. , 1983, American Journal of Cardiology.

[14]  D. Durrer,et al.  Effects of cardiac rehabilitation after myocardial infarction: changes in coronary risk factors and long-term prognosis. , 1983, American heart journal.

[15]  I. Lukšić,et al.  Cardiac Rehabilitation after Acute Myocardial Infarction , 1983 .

[16]  R. Shephard,et al.  Relation of exercise to the recurrence rate of myocardial infarction in men. Ontario Exercise-Heart Collaborative Study. , 1983, The American journal of cardiology.

[17]  N. Jones,et al.  Predictors of dropout from cardiac exercise rehabilitation. Ontario Exercise-Heart Collaborative Study. , 1983, The American journal of cardiology.

[18]  R. Schlant,et al.  The Natural History of Coronary Heart Disease: Prognostic Factors After Recovery from Myocardial Infarction in 2789 Men The 5‐year Findings of the Coronary Drug Project prepared for the Coronary Drug Project Research Group bv , 1982, Circulation.

[19]  Humphrey Jh.  The value of immunological concepts in medicine. The Croonian Lecture 1981. , 1982 .

[20]  P. Cleary,et al.  The National Exercise and Heart Disease Project: Long-term psychosocial outcome. , 1982, Archives of internal medicine.

[21]  J. Goldberg,et al.  Mortality after first myocardial infarction. Search for a secular trend. , 1982 .

[22]  D L DeMets,et al.  Secondary prevention after myocardial infarction: a review of long-term trials. , 1982, Progress in cardiovascular diseases.

[23]  P. Sleight,et al.  EARLY REHABILITATION AFTER MYOCARDIAL INFARCTION , 1981, The Lancet.

[24]  P. Cleary,et al.  National Exercise and Heart Disease Project. Psychosocial changes observed during a low-level exercise program. , 1981, Archives of internal medicine.

[25]  C. A. Gilbert,et al.  Effects of a prescribed supervised exercise program on mortality and cardiovascular morbidity in patients after a myocardial infarction: The National Exercise and Heart Disease Project∗☆ , 1981 .

[26]  P. Siltanen,et al.  Five-year survival of 728 patients after myocardial infarction. A community study. , 1980, British heart journal.

[27]  H. Hämäläinen,et al.  REDUCTION IN SUDDEN DEATHS BY A MULTIFACTORIAL INTERVENTION PROGRAMME AFTER ACUTE MYOCARDIAL INFARCTION , 1979, The Lancet.

[28]  W. Kannel,et al.  Prognosis after initial myocardial infarction: the Framingham study. , 1979, The American journal of cardiology.

[29]  C. Helmers,et al.  Mortality pattern among initial survivors of acute myocardial infarction using a life-table technique. , 2009, Acta medica Scandinavica.

[30]  I. Palatsi.  Feasibility of physical training after myocardial infarction and its effect on return to work, morbidity and mortality. , 1976, Acta medica Scandinavica. Supplementum.

[31]  L. Wilhelmsen,et al.  A controlled trial of physical training after myocardial infarction. Effects on risk factors, nonfatal reinfarction, and death. , 1975, Preventive medicine.

[32]  G. Michaelson.  Percutaneous puncture of the renal pelvis, intrapelvic pressure and the concentrating capacity of the kidney in hydronephrosis. , 1974, Acta medica Scandinavica. Supplementum.

[33]  E. Kentala.  Physical fitness and feasibility of physical rehabilitation after myocardial infarction in men of working age. , 1972, Annals of clinical research.

[34]  C. W. Frank,et al.  Prognosis of men after first myocardial infarction: mortality and first recurrence in relation to selected parameters. , 1968, American journal of public health and the nation's health.

[35]  W. Haenszel,et al.  Statistical aspects of the analysis of data from retrospective studies of disease. , 1959, Journal of the National Cancer Institute.