Cor Vasa 2004, 45(1):29-35
The effect of a rehabilitation program on the prognosis of myocardial infarction survivors
- Oddělení funkčního vyšetřování, Fakultní nemocnice, Brno-Bohunice, Brno, Česká republika
Aim of study:
To assess, in long-term follow-up, overall and cardiovascular mortality and the incidence of cardiovascular events (reinfarction, revascularization) in myocardial infarction (MI) survivors undergoing a rehabilitation program. Another objective was to assess the prognostic value of some clinical and exercise markers.
Patients and methods:
Patients after a myocardial infarction or a revascularization procedure for angina pectoris were included into a two-month outpatient program. Patients had three exercise sessions per week in groups of 4-6 persons. The total number of patients is 582 (89% of men and 11% of women), with a mean age of 56 ± 11 years. Enrolled are patients undergoing the rehabilitation program from 1993 through 2002. Before inclusion into the rehabilitation program and upon its completion, patients were examined by exercise echocardiography (EE). Prognostic evaluation was made using data obtained from EE at the end of the rehabilitation program.
Results:
The rehabilitation program was associated with a statistically significant improvement of exercise tolerance. The mean values of the whole group were 1.5 ± 0.3 W/kg and 1.7 ± 0.4 W/kg prior to and at the end of the rehabilitation program, respectively. Forty-four patients (7.6%) patients died during the follow-up period. The ten-year survival rate is 84%. There were 26 deaths (4.6%) from cardiovascular causes during follow-up. The one- and five-year mortality rates are 0.94% and 2,85 %, respectively. The ten-year survival rate is 90%. The questionnaire-based survey furnished the following information: 35 patients (6.2%) had recurrent MI. Revascularization after the rehabilitation program was performed in 82 patients (14.2%). The mean interval to revascularization was 3.1 ± 2.3 years. Predictors of death included both exercise tolerance and some markers of left ventricular function and morphology.
Conclusion:
Improved exercise tolerance is an important effect of rehabilitation and a major predictive marker of prognosis. Rehabilitation and physical activity should make an integral part of comprehensive management of coronary heart disease.
Keywords: Myocardial infarction; Cardiovascular rehabilitation; Prognosis of myocardial infarction survivors
Published: January 1, 2004 Show citation