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Published on: May 28, 2019
Bed rest for acute uncomplicated myocardial infarction
1University of Vienna, Medical Faculty, Department of Emergency Medicine, Vienna General Hospital;, Währinger Gürtel 18-20 / 6D, Vienna, Austria. harald.herkner@meduniwien.ac.at
Insights
Shorter bed rest durations (2-12 days) for acute myocardial infarction (AMI) patients are as safe as longer periods. Current guidelines lack evidence, and optimal bed rest duration for AMI remains unknown.
Area of Science:
- Cardiology
- Clinical Trials
- Evidence-Based Medicine
Background:
- Bed rest is standard for acute myocardial infarction (AMI) patients, but duration varies.
- Current guidelines recommend at least 12 hours of bed rest for uncomplicated ST-elevation myocardial infarction (STEMI).
- The evidence supporting current bed rest recommendations for AMI is unclear.
Purpose of the Study:
- To compare the safety and efficacy of short versus longer bed rest durations in patients with uncomplicated AMI.
Main Methods:
- Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
- Searched multiple databases including Cochrane, MEDLINE, EMBASE, PASCAL BioMed, PsycINFO, and BIOSIS Previews.
- Independent data extraction and verification by at least two investigators.
Main Results:
- 15 trials involving 1487 patients on short bed rest (median 6 days) and 1471 on longer bed rest (median 13 days) were analyzed.
- No significant difference in all-cause mortality, cardiac mortality, or reinfarction rates between short and longer bed rest groups.
- Studies were generally outdated with moderate to poor methodological quality.
Conclusions:
- Bed rest durations from 2 to 12 days appear safe for uncomplicated AMI patients.
- Current recommendations for bed rest duration in AMI are not well-supported by existing evidence.
- There is a need for high-quality trials to determine the optimal bed rest duration for AMI patients.
Background:
Bed rest is prescribed to all patients with acute myocardial infarction (AMI), but to a variable extent. Current guidelines (American College of Cardiology/ American Heart Association) recommend at least 12 hours bed rest in patients with uncomplicated ST-elevation myocardial infarction, however the basis for this recommendation is unclear.
Objectives:
To compare the effects of short versus longer bed rest in patients with uncomplicated AMI.
Search Strategy:
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2005), MEDLINE (January 1966 - August 2005), EMBASE (January 1988 - August 2005), PASCAL BioMed (January 1996 - August 2005); PsycINFO (January 1966 - August 2005) and BIOSIS Previews (January 1990 - August 2005).
Selection Criteria:
Randomised and quasi-randomised controlled trials of short versus longer bed rest in patients with uncomplicated AMI were sought.
Data Collection And Analysis:
Study selection was performed independently by at least two investigators according to the predefined inclusion criteria. Data were extracted by two investigators independently and in duplicate. Authors were contacted to obtain missing information.
Main Results:
We found 15 trials with 1487 patients assigned to a short period of bed rest (median 6 days) and 1471 patients assigned to longer bed rest (median 13 days). Generally the studies were outdated and appeared to be of moderate to poor methodological reporting quality. There was no evidence that shorter bed rest was more harmful than longer bed rest in terms of all cause mortality (RR=0.85 (95%CI 0.68 to 1.07), cardiac mortality (RR=0.81 (95%CI 0.54 to 1.19), or reinfarction (RR=1.07 (95%CI 0.79 to 1.44)).
Authors' Conclusions:
Bed rest ranging from 2 to 12 days appears to be as safe as longer periods of bed rest. The quality of most trials is unsatisfactory. Current bed rest recommendations are not supported by the existing evidence as the optimal duration of bed rest is unknown. The lack of adequate trials is surprising, considering the large size of several studies to compare effectiveness of drugs on people with AMI.
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