A prospective controlled study of in-hospital myocardial infarction rehabilitation

Data from a study of 97 consecutive patients who participated in a comprehensive in hospital rehabilitation program were compared with data on 100 patients treated conventionally at the same hospital. All patients were under age 65 and were suffering from their first myocardial infarction or had no sequelae from a previous infarction. The rehabilitation program consisted of education of the patient and family, vocational rehabilitation counseling, and supervised, graded exercise. Treatment effects were measured three months and one year after discharge. When compared with control group patients at the three-month follow-up, treated patients more frequently followed the recommended diet (P <.001), lost more weight (P =.02), were more active with leisure walking (P =.04), had lower serum cholesterol (P =.01), and had less severe angina pectoris (P =.007). However, at three-month follow-up the program was not associated with better exercise capacity or with lower rates of death, reinfarction, or smoking. At one-year follow-up, only the statistically significant difference in serum cholesterol persisted (P =.005). No new differences appeared. There was a nonsignificant trend for intervention group patients to return to work slightly later in the course of recovery than did the control group patients. Thus, this in-hospital rehabilitation program influenced behavior in a favorable manner, but the influence tended to decay over the observation period and was not strong enough to affect outcomes. It was concluded that the immediate convalescent period is an appropriate time to effectively introduce the patient to behavioral changes, but for sustained behavioral change leading to improved survival, the intervention must be followed by continued support after hospital discharge.