Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: A new model for patient care

doi:10.1016/0002-9149(85)90355-8

The American Journal of Cardiology

Volume 55, Issue 4, 1 February 1985, Pages 251-257

https://doi.org/10.1016/0002-9149(85)90355-8 Get rights and content

Abstract

Medically directed at-home rehabilitation was compared with group rehabilitation which began 3 weeks after clinically uncomplicated acute myocardial infarction (AMI) in 127 men, mean age 53 ± 7 years. Between 3 and 26 weeks after AMI, adherence to individually prescribed exercise was equally high (at least 71%), the increase in functional capacity equally large (1.8 ± 1.0 METs) and nonfatal reinfarction and dropout rates equally low (both 3% or less) in the 66 men randomized to home training and the 61 men randomized to group training. No training-related complications occurred in either group. The low rate of reinfarction and death (5% and 1%, respectively) in the study as a whole, which included 34 patients with no training and 37 control patients, reflected a stepwise process of clinical evaluation, exercise testing at 3 weeks and frequent telephone surveillance of patients who underwent exercise training. Medically directed at-home rehabilitation has the potential to increase the availability and to decrease the cost of rehabilitating low-risk survivors of AMI.

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Cited by (142)

Early Exercise-Based Rehabilitation Improves Health-Related Quality of Life and Functional Capacity After Acute Myocardial Infarction: A Randomized Controlled Trial
2015, Canadian Journal of Cardiology
Citation Excerpt :
Depression is a negative factor after AMI, not only for precipitating psychological complications but also for increasing the risk for new coronary events. Studies indicate a significant increase in functional capacity in patients undergoing exercise training at home after AMI.25,26 The present study found similar results, and patients who underwent an unsupervised walking program showed a statistically significant improvement in distance of 20% (85 m) compared with a 3% (13 m) increase in the CG.
The purpose of this study was to evaluate the influence of an early cardiac rehabilitation (CR) program on health-related quality of life (HRQL) and functional capacity in patients who recently experienced an acute myocardial infarction (AMI). This program was initiated in the inpatient setting and was followed by an unsupervised outpatient intervention.
After the same inpatient care plan, low-risk patients who experienced an AMI were randomized into 2 groups: (1) a control group (CG) (n = 43) entailing usual care and (2) an intervention group (IG) (n = 45) entailing outpatient (unsupervised) CR primarily centered on a progressive walking program. Initially, all patients underwent a supervised exercise program with early mobilization beginning 12 hours after an AMI. On hospital discharge, all patients were classified according to cardiovascular risk. Quality of life was evaluated by the MacNew Heart Disease HRQL questionnaire 30 days after discharge. Functional capacity was determined by a 6-minute walk test (6MWT) distance on the day of inpatient discharge as well as 30 days afterward.
The HRQL global score was higher in the IG compared with the CG 30 days after discharge (P < 0.001); physical and emotional domain scores were both significantly higher in the IG (P < 0.001). Furthermore, the IG showed a greater 6MWT distance compared with the CG (P < 0.001).
A CR program based on early progressive exercises, initiated by supervised inpatient training and followed by an unsupervised outpatient program, improved HRQL and functional capacity in patients at low cardiovascular risk who recently experienced an AMI.
Le but de cette étude était d’évaluer l’influence d’un programme de réadaptation cardiaque (RC) précoce sur la qualité de vie liée à la santé (QdVS) et la capacité fonctionnelle des patients qui avaient récemment subi un infarctus du myocarde aigu (IMA). Ce programme qui avait été mis en place en milieu hospitalier était suivi d’une intervention ambulatoire non supervisée.
Après le même plan de soins en milieu hospitalier, les patients exposés à un risque faible qui subissaient un IMA étaient répartis de manière aléatoire en 2 groupes : 1) un groupe témoin (GT; n = 43) comportant les soins habituels; 2) un groupe d’intervention (GI; n = 45) comportant une RC (non supervisée) ambulatoire principalement axée sur un programme de marche progressive. Au début, tous les patients entreprenaient un programme supervisé d’exercices favorisant la mobilisation précoce 12 heures après l’IMA. Au congé de l’hôpital, tous les patients étaient classifiés selon leur risque cardiovasculaire. La qualité de vie était évaluée à l’aide du questionnaire de QdVS en cardiologie MacNew 30 jours après le congé. La capacité fonctionnelle était déterminée par la distance parcourue au test de marche de 6 minutes (TM6M) le jour du congé de l’hôpital ainsi que 30 jours après.
Le score global de la QdVS était plus élevé dans le GI que dans le GT 30 jours après le congé (P < 0,001); les scores sur les plans physique et émotionnel étaient plus élevés dans le GI (P < 0,001). De plus, le GI parcourait une plus grande distance au TM6M que le GT (P < 0,001).
Un programme de RC basé sur des exercices progressifs précoces, qui débute par un entraînement supervisé en milieu hospitalier et est suivi d’un programme ambulatoire non supervisé, améliorait la QdVS et la capacité fonctionnelle des patients exposés à un faible risque cardiovasculaire qui avaient récemment subi un IMA.
40 years of cardiac rehabilitation and secondary prevention in post-cardiac ischaemic patients. Are we still in the wilderness?
2015, International Journal of Cardiology
Citation Excerpt :
DeBusk's group performed a series of elegant randomised trials which confirmed and expanded on some of Jelinek's observations. They found that home training was equally safe and effective as medically supervised training and superior to no training in terms of aerobic capacity [30,31]. Goble and Worcester showed that moderate intensity exercise resulted in similar improvements to high intensity exercise in the health state of men after transmural AMI.
Cardiac rehabilitation (CR) is the sum of interventions required to ensure the best physical, psychological and social conditions so that patients with cardiac disease may assume their place in society and slow the progression of the disease. Exercise testing (ET) early after MI has been shown to result in earlier return to work than the non-performance of ET. Research quality CR has resulted in lower cardiovascular mortality and lower recurrent hospitalisation and has been shown to be cost-effective. However, the content of cardiac rehabilitation programmes varies considerably. The only randomised trial of CR as usually performed in the ‘real world’ showed that CR had no impact on cardiac death rates or any other outcome. Only 20–50% of eligible patients attend CR programmes and attendance at CR has not improved in the last 20 years despite major attempts to increase participation in CR. Alternative methods for provision of CR have been sought. These include home-based CR, case management approaches, and nurse coordinated prevention programmes. Telephone based programmes, such as The COACH Program, have been introduced to coach patients and improve behavioural and biomedical risk factors. These have been shown to improve risk factors better than usual patient care and to reduce recurrences of cardiac events after discharge from hospital due to MI. Expansion of novel approaches such as The COACH Program may help to counteract the non-attendance at CR.
The integrated team approach to the care of the patient with cardiovascular disease
2012, Current Problems in Cardiology
Citation Excerpt :
Chaplains and spiritual counselors In this context, some of the original scientific clinical research was published relative to the team approach, especially with regard to the role of exercise in the patient with CVD.5-11 Over time, the team concept has evolved in other subsets of care for the patient with CVD.
Cardiovascular disease (CVD) is a costly, worldwide problem with significant annual morbidity and mortality. Guideline-based primary and secondary prevention is effective in preventing and controlling CVD. Such prevention must be implemented by an integrated team of physician-directed health professionals, during both the inpatient and the outpatient phases of care. Appropriate team members may include, but are not limited to, nurses, advanced practice nurses, physician assistants, dietitians, physical therapists, psychologists, pharmacists, cardiac fellows, exercise physiologists, and case managers. During the acute phase of care, various teams are activated as appropriate to specific needs of the patient in the medical (invasive and noninvasive) and surgical specialties. The outpatient phase varies with diagnosis and condition of the patient and team members are involved as needed. An integrated team effort is essential to the best care for each patient regarding individual management and will assure that evidence-based guidelines, in both treatment and secondary prevention, are implemented.
Rehabilitation of the Patient with Cardiovascular Disease
2012, Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease: Fourth Edition
A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease
2010, European Journal of Cardiovascular Prevention and Rehabilitation
A variety of different types of secondary prevention programs for coronary heart disease (CHD) exist. Home-based programs have become more common and may be more accessible or preferable to some patients. This review compared the benefits and costs of home-based programs with usual care and cardiac rehabilitation.
A meta-analysis following a systematic search of 19 databases, existing reviews, and references was designed. Studies evaluated home-based interventions that addressed more than one main CHD risk factor using a randomized trial with a usual care or cardiac rehabilitation comparison group with data extractable for CHD patients only and reported in English as a full article or thesis.
Thirty-nine articles reporting 36 trials were reviewed. Compared with usual care, home-based interventions significantly improved quality of life [weighted mean difference: 0.23; 95% confidence interval (95% CI): 0.02–0.45], systolic blood pressure (weighted mean difference: -4.36 mmHg; 95% CI: -6.50 to -2.22), smoking cessation (difference in proportion: 14%; 95% CI: 0.02–0.26), total cholesterol (standardized mean difference: -0.33; 95% CI: -0.57 to -0.08), and depression (standardized mean difference: -0.33; 95% CI: -0.59 to -0.07). Effect sizes were small to moderate and trials were of low-to-moderate quality. Comparisons with cardiac rehabilitation could not be made because of the small number of trials and high levels of heterogeneity.
Home-based secondary prevention programs for CHD are an effective and relatively low-cost complement to hospital-based cardiac rehabilitation and should be considered for stable patients less likely to access or adhere to hospital-based services.
Home-based versus centre-based cardiac rehabilitation
2023, Cochrane Database of Systematic Reviews

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^☆: This study was supported by Grant HL18907 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland and by a grant from the PepsiCo Foundation, Purchase, New York.

^∗: With the collaboration of YMCArdiac Therapy Programs in Palo Alto and San Jose, California.

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Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: A new model for patient care☆

Abstract

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Prev Med

Lancet

Am J Cardiol

Prev Med

Prognostic value of exercise testing soon after myocardial infarction

N Engl J Med

Risk stratification with low-level exercise testing 2 weeks after acute myocardial infarction

Circulation

The prognostic value of submaximal exercise testing with radionuclide ventriculography before hospital discharge in patients with recent myocardial infarction

Circulation