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Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials
N B Oldridge1, G H Guyatt, M E Fischer
1Department of Medicine, University of Wisconsin Medical School--MCC, Milwaukee.
Insights
Comprehensive cardiac rehabilitation significantly reduces mortality after myocardial infarction. This meta-analysis of ten trials shows improved survival rates for patients undergoing cardiac rehab, though it doesn't impact recurrent heart attacks.
Area of Science:
- Cardiology
- Clinical Trials
- Public Health
Background:
- Randomized trials of cardiac rehabilitation post-myocardial infarction often show reduced mortality, but significance is inconsistent.
- Small patient numbers in individual trials limit the detection of small, clinically relevant mortality benefits.
Purpose of the Study:
- To determine the effect of cardiac rehabilitation on mortality and recurrent myocardial infarction.
- To overcome statistical limitations in small trials through meta-analysis.
Main Methods:
- A meta-analysis was conducted on ten randomized clinical trials.
- Combined data from 4347 patients (2145 control, 2202 rehabilitation).
Main Results:
- Pooled odds ratio for all-cause death was 0.76 (95% CI, 0.63 to 0.92).
- Pooled odds ratio for cardiovascular death was 0.75 (95% CI, 0.62 to 0.93).
- No significant difference in nonfatal recurrent myocardial infarction was observed.
Conclusions:
- Comprehensive cardiac rehabilitation offers a significant survival benefit for appropriately selected myocardial infarction patients.
- Cardiac rehabilitation does not appear to reduce the risk of nonfatal recurrent myocardial infarction.
Abstract:
Randomized clinical trials of cardiac rehabilitation following myocardial infarction have typically demonstrated a lower mortality in treated patients, but with a statistically significant reduction in only one trial. To overcome the problem of not being able to detect small but clinically important benefits in mortality in randomized clinical trials of exercise and risk factor rehabilitation after myocardial infarction with small numbers of patients, we carried out a meta-analysis on the combined results of ten randomized clinical trials that included 4347 patients (control, 2145 patients; rehabilitation, 2202 patients). The pooled odds ratios of 0.76 (95% confidence intervals, 0.63 to 0.92) for all-cause death and of 0.75 (95% confidence intervals, 0.62 to 0.93) for cardiovascular death were significantly lower in the rehabilitation group than in the control group, with no significant difference for nonfatal recurrent myocardial infarction. These results suggest that, for appropriately selected patients, comprehensive cardiac rehabilitation has a beneficial effect on mortality but not on nonfatal recurrent myocardial infarction.