[Postmyocardial infarction cardiac rehabilitation in low risk patients. Results with a coordinated program of cardiological and primary care]. Cardiac rehabilitation: health characteristics and socio-economic status among those who do not attend. Short-term comprehensive cardiac rehabilitation after AMI is associated with reduced 1-year mortality: results from the OMEGA study Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction Prognostic Influences of Cardiac Rehabilitation in Korean Acute Myocardial Infarction Patients Effect of early short-term cardiac rehabilitation after acute ST-elevation and non-ST-elevation myocardial infarction on 1-year mortality Checklists of methodological issues for review authors to consider when including non-randomized studies in systematic reviews. Effect of Intense Lifestyle Modification and Cardiac Rehabilitation on Psychosocial Cardiovascular Disease Risk Factors and Quality of Life
INTRODUCTION AND OBJECTIVES To assess the efficacy of cardiac rehabilitation with a mixed primary and cardiological care program in patients with low-risk myocardial infa rct ion . PATIENTS AND METHOD The participants in this 12-month prospect i ve study were 153 consecutive patients with low-risk myocardial infa rct ion ( MI ) referred to their primary care center for follow-up care . Of these patients , 113 were referred to a mixed primary and specialized care program that included physical exercise , cardiovascular risk control , an antismoking program , health education talks and psychological evaluation . The other 40 patients served as controls . We analyzed the results after 3 months and 1 year of follow-up . RESULTS There were no differences between the two groups at baseline . After 1 year , improvements were seen in smoking habit ( 4.6 % vs 15.6 % ; P<.05 ) and body mass index ( 26 [ 2 ] vs 29 [ 2 ] ; P<.05 ) . Dyslipidemia , glucose and blood pressure were similar in both groups after follow-up . Greater improvements in the group of patients who participated in the program were seen after 1 year in quality of life ( 78 [ 2 ] vs 91 [ 2 ] ; P<.05 ) , exercise capacity ( 10.3 [ 2 ] vs 8.4 [ 3 ] ; P<<.01 ) and return to active employment ( 84.6 % vs 53.3 % ; P<.05 ) . CONCLUSIONS After 1 year of follow-up , the cardiac rehabilitation program coordinated by cardiological and primary care services for low-risk post-MI patients improved quality of life , and increased exercise tolerance , active employment , and the number of participants who quit smoking . The mixed program also reduced body mass index . These results suggest the need for similar programs BACKGROUND Cardiac rehabilitation ( CR ) is well documented , in r and omised trials , to reduce mortality risk after myocardial infa rct ion ( MI ) . Selection of healthy patients for CR  is a relatively unexplored problem . Our aims were to identify predictors of CR-attendance and to describe the prognosis as concerns mortality , re-admission and invasive treatment among CR-attendees as compared to  CR-non-attendees  . METHODS From a cohort of 138 290 persons aged 30 - 69 years , we identified consecutive MI patients , between 1 April 2000 and 31 March 2002 . There were 206 MI patients , who survived until admission , and among the 200 who survived 30 days , 145 ( 72.5 % ) attended a comprehensive CR programme . Data were obtained from patient charts and from Danish population registers , and as a result we had no non-participation for the study . RESULTS The 2-year mortality proportions for patients surviving the first 30 days of admission were 2.8 and 21.8 % among CR-attendees and CR-non-attendees , respectively ( P < 0.0001 ) . Among CR-non-attendees , there was a smaller fraction having an invasive treatment performed as compared with CR-attendees . By multiple logistic regression controlling for age and sex , CR-attendance was associated with chest pain , whereas CR-non-attendance was associated with low gross income , single living and inverted T-wave in the electrocardiogram . CONCLUSION  CR attendance rate was 72.5 % . Non-attendees have a higher mortality risk , which in part may be attributed to selection of healthy patients . Non-attendees are older and more likely to have atypical symptoms at admission , a low socioeconomic status and to live alone . Special attention is needed to improve CR attendance among such patients Background The prognostic effect of early , comprehensive short-term cardiac rehabilitation on top of current , guideline -adjusted treatment of acute myocardial infa rct ion has not sufficiently been evaluated . Design Prospect i ve cohort study . Methods Within the OMEGA study population , the clinical course of 3560 patients still alive 3 months after acute myocardial infa rct ion were evaluated by comparing patients who had attended to cardiac rehabilitation ( 70.6 % ) with those who did not .  Total mortality and major adverse cerebrovascular and cardiovascular events , as well as non-fatal events , were evaluated within the time period of 4–12 months after hospital admission for acute myocardial infa rct ion . The effect of cardiac rehabilitation on clinical events was estimated by using the propensity score method to adjust for confounding parameters in multivariate analysis . Results Patients participating in cardiac rehabilitation  were younger , more often had acute revascularization  , less often experienced non-ST-elevation myocardial infa rct ion , and less often had a history of diabetes or cardiovascular events . Total mortality ( OR 0.46 , 95 % CI 0.27–0.77 ) and major adverse cerebrovascular and cardiovascular events ( OR 0.53 , 95 % CI 0.38–0.75 ) were significantly lower in the rehabilitation group . Subgroup analysis including major clinical characteristics also revealed significantly reduced rates of total death and major adverse cerebrovascular and cardiovascular events in the rehabilitation group . Conclusions Attendance to early , comprehensive short-term cardiac rehabilitation programmes on top of current guideline -adjusted treatment of acute myocardial infa rct ion is associated with a significantly improved 1-year prognosis Background It is widely believed that cardiac rehabilitation following acute myocardial infa rct ion ( MI ) reduces mortality by approximately 20 % . This belief is based on systematic review s and meta-analyses of mostly small trials undertaken many years ago . Clinical management has been transformed in the past 30–40 years and the findings of historical trials may have little relevance now . Objectives The principal objective was to determine the effect of cardiac rehabilitation , as currently provided , on mortality , morbidity and health-related quality of life in patients following MI . The secondary objectives included seeking programmes that may be more effective and characteristics of patients who may benefit more . Design , setting , patients , outcome measures A multi-centre r and omised controlled trial in representative hospitals in Engl and and Wales compared 1813 patients referred to comprehensive cardiac rehabilitation programmes or discharged to ‘ usual care ’ ( without referral to rehabilitation ) .  The primary outcome measure was all-cause mortality at 2 years . The secondary measures were morbidity , health service use , health-related quality of life , psychological general well-being and lifestyle cardiovascular risk factors at 1 year . Patient entry ran from 1997 to 2000 , follow-up of secondary outcomes to 2001 and of vital status to 2006 . A parallel study compared 331 patients in matched ‘ elective ’ rehabilitation and ‘ elective ’ usual care ( without rehabilitation ) hospitals . Results There were no significant differences between patients referred to rehabilitation and controls in mortality at 2 years ( RR 0.98 , 95 % CI 0.74 to 1.30 ) or after 7–9 years ( 0.99 , 95 % CI 0.85 to 1.15 ) , cardiac events , seven of eight domains of the health-related quality of life scale ( ‘ Short Form 36 ’ , SF36 ) or the psychological general well-being scale . Rehabilitation patients reported slightly less physical activity . No differences between groups were reported in perceived overall quality of cardiac aftercare . Data from the ‘ elective ’ hospitals comparison concurred with these findings . Conclusion In this trial , comprehensive rehabilitation following MI had no important effect on mortality , cardiac or psychological morbidity , risk factors , health-related quality of life or activity . This finding is consistent with systematic review s of all trials reported since 1983 . The value of cardiac rehabilitation as practised in the UK is open to question Objective To observe the prognostic influences of the cardiac rehabilitation ( CR ) program in Korean acute myocardial infa rct ion ( AMI ) patients during the first year after an occurrence of the disease . Method A total of 141 AMI patients who underwent percutaneous coronary intervention ( PCI )  were recruited consecutively for this study and divided into the CR group and the control group . The CR group completed the phase 2 CR program in the hospital for a period of 6 - 8 weeks and maintained self-exercise in their community by exercise prescription for a year after AMI . We performed a prospect i ve comparison of the patients ' demographic data , high sensitive C-reactive protein ( hs-CRP ) level after the 4-month CR program , and the rate of recurrence ( AMI , re-hospitalization , positive coronary angiogram , needed revascularization procedure , or death ) between the two groups . Results Compared to the control group ( 0.33±0.48 mg/dl ) , the hs-CRP level was lower in the CR group ( 0.18±0.32 mg/dl ) after 4 months of exercise . The recurrence rate was lower ( 10 % , 7/69 ) in the CR group , compared to the control group ( 24 % , 17/72 , p<0.05 ) . The number of disease-free days was larger in the CR group ( 354±38.34 ) , compared to the control group ( 316±99.96 , p<0.05 ) . In a comparison of statistical methods used for testing the e quality of two survivor distributions , the CR group showed a lower recurrence rate than the control group ( p<0.05 ) . Conclusion Participation in the CR program design ed for AMI patients who underwent PCI-induced normalization of the serum hs-CRP level and lowering of the recurrence rate by 14 % during the first year Abstract Objectives : The aim was to evaluate the effect of short-term cardiac rehabilitation ( CR ) on clinical events during a 1-year follow-up after acute myocardial infa rct ion . Methods : From the observational , prospect i ve Acute COronary Syndromes ( ACOS ) registry , 4547 consecutive patients after ST-elevation ( STEMI : n = 2432 ) or non-ST-elevation myocardial infa rct ion ( NSTEMI : n = 2115 ) , recruited between June 2000 and December 2002 , were characterised and evaluated for clinical outcomes during a 1-year follow-up . From the STEMI group 67.8 % and from the NSTEMI group 52.3 % participated in cardiac rehabilitation ( CR+ ) . Results : Age > 70 years and previous myocardial infa rct ion were independent predictors not to attend CR in STEMI and NSTEMI patients , whereas early revascularisation ( < 48 hours after hospital admission ) was associated with increased likelihood to undergo CR . Multivariable analysis adjusting for propensity score shows that CR+ was independently associated with a significant reduction of all-cause mortality ( STEMI : OR 0.41 , 95 % CI 0.28–0.60 ; NSTEMI : OR 0.53 , 95 % CI 0.38–0.76 ) and major adverse cardiac and cerebrovascular events ( MACCE ; STEMI : OR 0.66 , 95 % CI 0.49–0.89 ; NSTEMI : OR 0.73 , 95 % CI 0.55–0.98 ) during a 1-year follow-up . Conclusion : The study shows an independent and strong association of CR+ with markedly reduced total mortality and MACCE during a 1-year follow-up after STEMI or NSTEMI . The limitation of the study is that it is not a prospect i ve r and omised trial . Furthermore , unequal distribution of risk factors relevant for long-term prognosis had to be corrected by multivariable analysis adjusting for propensity score BACKGROUND There is increasing interest from review authors about including  non-r and omized studies  ( NRS ) in their systematic review s of health care interventions . This series from the Ottawa Non-R and omized Studies Workshop consists of six papers identifying method ological issues when doing this . AIM To format the guidance from the preceding papers on study design and bias , confounding and meta- analysis , selective reporting , and applicability/directness into checklists of issues for review authors to consider when including NRS in a systematic review . CHECKLISTS Checklists were devised providing frameworks to describe/assess : ( 1 ) study design s based on study design features ; ( 2 ) risk of residual confounding and when to consider meta-analysing data from NRS ; ( 3 ) risk of selective reporting based on the Cochrane framework for detecting selective outcome reporting in trials but extended to selective reporting of analyses ; and ( 4 ) directness of evidence contributed by a study to aid integration of NRS findings into summary of findings tables . SUMMARY The checklists described will allow review groups to operationalize the inclusion of NRS in systematic review s in a more consistent way . The next major step is extending the existing Cochrane Risk of Bias tool so that it can assess the risk of bias to NRS included in a review . Copyright © 2013 John Wiley & Sons , This study examined the effect of the Ornish Program for Reversing Heart Disease and cardiac rehabilitation(CR )  on psychosocialrisk factors and quality of life in patients with confirmedcoronary artery disease . Participants had previously undergone a revascularization procedure . The 84 patients self-selected to participate in the Ornish Program for Reversing Heart Disease ( n = 507 28 ) , CR ( n = 28 ) , or a control group ( n = 28 ) . Twelve psychosocial risk factors and quality of life variables were collected from all three groups at baseline , 3 months , and 6 months . At 3 and 6 months , Ornish group participants demonstrated significant improvements in all 12 outcome measures . The rehabilitationgroupimproved in 7 of the 12 , and the controlgroupshowed significant improvements in 6 of the variables . Intensive lifestyle modification programs significantly affect psychosocial risk factors and quality of life
BACKGROUND The beneficial effects of cardiac rehabilitation ( CR ) have been challenged in recent years and there is now a need to investigate whether current CR programmes , delivered in the context of modern cardiology , still benefit patients .