Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial.

OBJECTIVE

To evaluate rehabilitation after myocardial infarction.

DESIGN

Randomised controlled trial of rehabilitation in unselected myocardial infarction patients in six centres, baseline data being collected on admission and by structured interview (of patients and spouses) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months.

SETTING

Six district general hospitals.

SUBJECTS

All 2328 eligible patients admitted over two years with confirmed myocardial infarction and discharged home within 28 days.

INTERVENTIONS

Rehabilitation programmes comprising psychological therapy, counselling, relaxation training, and stress management training over seven weekly group outpatient sessions for patients and spouses.

MAIN OUTCOME MEASURES

Anxiety, depression, quality of life, morbidity, use of medication, and mortality.

RESULTS

At six months there were no significant differences between rehabilitation patients and controls in reported anxiety (prevalence 33%) or depression (19%). Rehabilitation patients reported a lower frequency of angina (median three versus four episodes a week), medication, and physical activity. At 12 months there were no differences in clinical complications, clinical sequelae, or mortality.

CONCLUSIONS

Rehabilitation programmes based on psychological therapy, counselling, relaxation training, and stress management seem to offer little objective benefit to patients who have experienced myocardial infarction compared with previous reports of smaller trials.