Rehabilitation following myocardial infarction: Evaluation of both ‘fast-track’ and low level exercise on both physical and psychological parameters

Abstract

Following acute myocardial infarction (AMI), anxiety and depression usually occur early after discharge at a time of transition from highly supervised care to little support at home. In 1993 we initiated a ‘fast-track’ programme, starting full cardiac rehabilitation within 14 days of AMI. Retrospectively, we analysed and compared records of the first 100 patients to enter the fast-track programme with the last 100 patients to enter the standard programme (rehabilitation starting 4–6 weeks following AMI) with follow-up of 42 months. Satisfactory records for 90 standard and 93 fast-track patients aged 27–64 years were obtained. Over 90% of patients completed rehabilitation with high satisfaction levels. Ages of both groups were the same (median 51 vs 52 years). Standard rehabilitation commenced 26–176 (median 54) days after AMI and fast-track rehabilitation commenced at 6–38 (median 12) days. No deaths from ischaemic heart disease occurred in either group. Coronary angiography was undertaken in 29 standard and in 30 fast-track patients. Revascularization was undertaken in 19 standard and in 17 fast-track patients. Hospital activity analysis showed that 25 standard and 21 fast-track patients were readmitted under a cardiologist (excluding intervention admissions). Some patients had multiple cardiology readmissions, making 48 episodes in the standard group and 28 in the fast-track group. This observation concurs with our impression that more fast-track patients rehabilitate satisfactorily. This experience shows that patients appreciate and attend early rehabilitation, which appears safe. A randomized controlled trial is planned to assess whether early rehabilitation improves outcomes following AMI and reduces costs of unnecessary admissions.