Cardiac rehabilitation after MI may not improve outcomes
MedWire News: Cardiac rehabilitation after myocardial infarction (MI) may not improve mortality, morbidity, or quality of life, suggest UK researchers.
"The value of cardiac rehabilitation as practised in the UK is open to question," write Robert West (University of Wales, Cardiff) and colleagues in the journal Heart.
They conducted a randomized controlled trial among 1813 patients who were either referred to comprehensive cardiac rehabilitation programs or discharged to usual care (without referral to rehabilitation).
A parallel study involved 331 patients in matched elective rehabilitation at hospitals with established programs, which were unwilling to randomize patients out of rehabilitation, and at hospitals unable to offer rehabilitation. All eligible consenting patients in "elective rehabilitation hospitals" were referred to rehabilitation, and those in "elective control" hospitals were allocated to receive usual care.
The findings revealed no significant difference in the mortality rate between patients referred to rehabilitation and control patients at 2 years or after 7-9 years.
There was also no significant difference in cardiovascular morbidity, including MI, stroke, and angina, between the two groups.
In addition, the rehabilitation and control groups did not differ significantly in terms of any of the eight domains of health-related quality of life, according to the Short-Form 36 Questionnaire, or three domains of psychologic general wellbeing (anxiety, depression, and positive wellbeing) according to the Psychological General Wellbeing Index.
Data from the parallel study of elective hospitals concurred with these findings, the authors note.
"As medical management has evolved over the past 30-40 years the scope for benefit from cardiac rehabilitation appears to have declined," they say.
West et al conclude: "Rehabilitation programmes may contribute to 'seamless patient care' and they are appreciated by many patients but evidence of objective benefit is weak relative to the proven benefits from other aspects of cardiac management."
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By Piriya Mahendra