5-year results of a comprehensive rehabilitation programme after myocardial infarction.

A comprehensive cardiac rehabilitation programme has been offered to a non-selected consecutive group of patients who have survived an acute myocardial infarction (MI). The programme includes follow-up at a post-MI clinic, physical training in outpatient groups, the provision of information on smoking and diet, and psychological support to patients and their families. The intervention group, consisting of the 147 patients participating in the programme has been compared with a nonselected consecutive reference group of 158 patients receiving standard care. During the five-year follow-up there was no difference in cardiac mortality between the groups, but the recurrence rate of non-fatal MI (17.3 vs 33.3%. P = 0.02) and the rate of total cardiac events was lower in the intervention group (39.5 vs 53.2%, P = 0.05). There was an alteration of risk factors, as there were fewer smokers and uncontrolled hypertensives in the intervention group. Patients in the reference group used more sedatives and long-acting nitroglycerine and had a lower return-to-work rate during the study period. The programme proved to be particularly effective in the age group below 55 years, where a significantly lower rate of total cardiac events was observed and more patients returned to work than in the reference group. It is concluded that the combined effect of the comprehensive programme has contributed to the long-term results, and that the programme offers an effective and safe method of secondary prevention after MI.