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Effects of an expanded cardiac rehabilitation programme in patients treated for an acute myocardial infarction or a coronary artery by-pass graft operation

Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, catrine.edstrom{at}ds.se

M Rydell Karlsson

Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm

NH Wallen

Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm

E. Billing

Department of Medical Sciences, Uppsala University, Uppsala

C. Held

Karolinska Institutet, Department of Cardiology, Karolinska University Hospital Solna, Stockholm, Sweden

Objective: To investigate the effects of expanded cardiac rehabilitation with multifactorial interventions on metabolic and inflammatory markers, exercise performance and on established cardiovascular risk factors.

Design: Single-centre prospective randomized controlled trial.

Setting: A university hospital.

Subjects: Two hundred and twenty-four patients with an acute myocardial infarction or patients undergoing coronary artery by-pass grafting.

Intervention: Patients were randomized to expanded cardiac rehabilitation including stress management, increased physical training, staying at a 'patient hotel' and cooking sessions, or to usual cardiac rehabilitation

Main measures: Biochemical risk markers and exercise performance; follow-up was one year.

Results: There were no significant differences between the two treatment groups in the changes of biochemical risk markers or in exercise performance. Thus, low-density lipoprotein (LDL)-cholesterol levels decreased from 3.00 (0.97) to 2.54 (0.66) mmol/L in the intervention group and from 3.20 (0.85) to 2.54 (0.63) mmol/L in the control group, fibrinogen levels decreased from 5.30 (2.00) to 4.25 (1.01) g/L in the intervention group and from 5.29 (1.89) to 4.33 (0.83) g/L in the control group and C-reactive protein (CRP) levels decreased from 3.04 (2.79) to 2.09 (2.13) mg/L in the intervention group and from 4.01 (3.49) to 2.39 (2.49) mg/L in the control group. Total workload (W) improved from 118 (35) to 136 (34) in the intervention group and from 117 (36) to 133 (39) in the control group.

Conclusion: There was no further significant benefit in biochemical risk markers or in exercise performance among patients undergoing the expanded rehabilitation as compared to the control group which received usual cardiac rehabilitation.

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