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  • Title: Can high-risk patients after myocardial infarction participate in comprehensive cardiac rehabilitation?
    Author: Hedbäck B, Perk J.
    Journal: Scand J Rehabil Med; 1990; 22(1):15-20. PubMed ID: 2326603.
    Abstract:
    Patients with large transmural infarctions (MI) and signs of congestive heart failure (CHF) are often excluded from physical training, because of the risk of malignant arrhythmia or cardiac overloading. From a non-selected MI population less than 65 years we enrolled 37 high-risk patients in a two-year comprehensive cardiac rehabilitation programme, including health education, follow-up at a post-MI clinic, and physical training in outpatient groups. The feasibility, effectiveness and safety of the physical training were evaluated: Twenty-one patients joined the physical training and participated with excellent compliance, reaching the preset levels of training. No adverse effects occurred during the 921 training sessions. The high-risk patients were compared with the remaining 228 patients and a subgroup of 86 low-risk patients with regard to mortality, morbidity, medication, effect on risk factors, exercise test performance and rate of return to work. The high-risk group showed a higher mortality (27.0 vs. 10.4%, p less than 0.05), a lower maximal work capacity at the exercise test 4 months after MI (126 W vs. 140 W, p less than 0.05), and a lower rate of early return to work (22.6 vs. 50% p less than 0.01) when compare with the low risk group. However, they showed a similar improvement in exercise test parameters. At the end of the programme a remarkable 63% had returned to work vs. 48.2% of the remaining patients. The reduction in smoking and the effect on blood pressure were equal in both groups. It is concluded that high-risk patients may well benefit from regular physical training in outpatient groups, if adequate medical supervision is available.
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