Lack of effect of bed rest and cigarette smoking on development of deep venous thrombosis after myocardial infarction. Randomised multicentre trial of early mobilisation after uncomplicated myocardial infarction. [Early mobilization in myocardial infarct]. Value of early ambulation in patients with and without complications after acute myocardial infarction. Effect of rapid mobilization on ejection fractions and ventricular volumes after acute myocardial infarction. [A controlled clinical study of early mobilisation of patients with myocardial infarction (author's transl)]. Controlled trial of early mobilisation and discharge from hospital in uncomplicated myocardial infarction. Early hospital discharge after myocardial infarction. Accelerated versus classical early mobilization after myocardial infarction. Early mobilization after myocardial infarction. A controlled study. The management of myocardial infarction with particular reference to the chair treatment. A controlled study of early discharge after uncomplicated myocardial infarction. Prevention of lower extremity venous thrombosis by early mobilization. Confirmation in patients with acute myocardial infarction by 125I-fibrinogen uptake and venography.
In a prospective study of patients admitted to a coronary care unit, the incidence of isotopically diagnosed deep venous thrombosis was found to be related to the severity of illness rather than to the duration of bed rest. In addition, no negative correlation was found between cigarette smoking and deep venous thrombosis. In a multicentre trial 742 patients in 13 hospitals in Wales were randomly allocated on the fifth day after uncomplicated myocardial infarction to be mobilised on the fifth or the tenth day. The trial shows no difference in first year mortality, nor in morbidity assessed after a median period of 13 months. Follow-up after one year suggests an unexplained lower mortality during the second and third years in the late mobilisation group. nan A prospective, controlled, randomized study was done to compare the effect of early and late ambulation in hospitalized patients with acute myocardial infarction. All patients surviving longer than the first five days were studied; 64 patients were mobilized on day six and discharged on day 12, and 65 were mobilized on day 13 and discharged on day 19. Follow-up observation lasted from six to 52 weeks. Of patients without complications until day six, eight out of 32 in the early and 16 of 35 in the late groups manifested complications during the follow-up period (p smaller than 0.05). Of those who had complications before day six, seven of 32 and 26 of 30 still had or acquired new complications until last seen (p small than 0.0001). The number of serious complications in the two groups was eight and 24 respectively (p smaller than 0.001). We conclude that early ambulation is beneficial irrespective of complications on admission. Despite the current practice of early mobilization and early hospital discharge after uncomplicated acute myocardial infarction (AMI), physicians are reluctant to permit normal physical and social activity for several weeks after the AMI "to allow the heart to heal." This study tested whether it was possible to identify a low risk group of patients on day 3 after AMI, and whether vigorous early mobilization from days 4 through 7 affected left ventricular function and volumes (studied by gated blood pool scan on days 4 and 14). There was 1 death in 3 months in 45 patients with uncomplicated AMI suitable for randomization to activity (group A) compared with 11 deaths in 55 patients unsuitable for rapid early mobilization (group B) (p less than 0.01). Early vigorous mobilization in 24 of the group A patients compared with sedentary care in 20 did not affect change in ejection fraction, end-diastolic volume, end systolic-volume, stroke volume, heart rate or cardiac output between days 4 and 14. A very low risk group suitable for early vigorous mobilization can be defined on day 3 after AMI; further, vigorous early mobilization does not affect left ventricular function or volumes. Early return to physical, social and occupational activity after uncomplicated AMI should result in marked reduction in direct and indirect costs of AMI. This is the report about 265 patients with recent transmural myocardial infarction. In the first week of hospital treatment 63 died. From the remaining 201 patients 101 fulfilled the conditions for early mobilisation of the WHO. In a controlled study these patients were divided in 2 groups: group 1 started the programme of early mobilisation the 7th day and group 2 was the control group which was mobilized after 3 weeks of bed rest. The 2 groups were comparable in the clinical course and had 2% of letality. The remaining 100 patients with conditions against early mobilisation were conservatively treated with 3 weeks of bed rest. The letality in this group was very high with 23%. nan nan nan nan nan Out of 383 myocardial infarction (MI) patients aged below 70 years, 252 (66%) were judged after the third day in hospital to have had uncomplicated infarctions. These patients were allocated at random to two groups, one of which was given treatment for 8 days and the other for 15 days. No significant differences in mortality, morbidity or incapacity for work could be detected during the three-month period of follow-up. The findings thus support previous conclusions that early discharge from hospital after uncomplicated MI is not associated with greater risk for the patient than later discharge. To determine the effects of early ambulation on peripheral venous thrombosis in the coronary care unit, 29 patients with acute myocardial infarction had daily 125I-fibrinogen point counting of both legs using a standard portable technique in the first 3 to 7 days after admission. Twenty-one patients underwent early ambulation during the initial 3 days, while 8 remained at complete bed rest for 5 days. Only 2 of 21 early ambulated patients had positive fibrinogen point counts, in contrast to 5 of 8 nonambulated patients (P less than 0.01). With heart failure, only 2 of 9 ambulated patients had positive point counts, compared with 4 of 5 nonambulated patients (P less than 0.05). In 16 patients undergoing venography, point counts were confirmed in 6 positive and 10 negative findings. These results show that the high frequency of peripheral venous thrombosis in immobilized acute myocardial infarction patients, particularly those with heart failure, can be effectively reduced by early ambulation.
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.