Cardiac rehabilitation

Abstract

Nancy Frasure-Smith and colleagues1Frasure-Smith N Lesperance F Prince RH et al.Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction.Lancet. 1997; 350: 473-479Summary Full Text Full Text PDF PubMed Scopus (419) Google Scholar show that a home-based psychosocial nursing intervention for cardiac patients does not have morbidity or mortality benefits as seen in a hospital-based group undergoing multifactorial cardiac rehabilitation interventions.2O'Connor GT Buring JE Jusuf S et al.An overview of randomised clinical trials of rehabilitation with exercise after myocardial infarction.Circulation. 1989; 80: 234-244Crossref PubMed Scopus (1121) Google Scholar Another randomised controlled trial of hospital-based psychosocial intervention in groups also demonstrated no benefit.3Jones DA West RR Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial.BMJ. 1996; 313: 1517-1521Crossref PubMed Scopus (208) Google Scholar Thus, the evidence is that psychosocial intervention alone does not have a beneficial effect on mortality rates. It is important to highlight the fact that psychosocial intervention s part of a multifactorial cardiac rehabilitation programme is associated with greatly increased benefits to patients. A recent meta-analysis4Linden W Stossel C Maurice J Psychosocial interventions for patients with coronary artery disease: a meta-analysis.Arch Intern Med. 1996; 156: 745-752Crossref PubMed Google Scholar identified 23 trials (n=3180 patients) that evaluated the impact of adding a psychosocial component to cardiac rehabilitation programmes. Patients receiving the psychosocial component in addition to the other aspects showed a greater reduction in psychological distress, systolic blood pressure, heart rate, and cholesterol. Mortality was 41% lower over the first 2 years than in those whose programme did not have this component, whereas cardiac recurrence rates were 46% lower. Cardiac rehabilitation, as recommended by professional associations,5Horgan JH Bethell H Carson P et al.British Cardiac Society Working Party report on cardiac rehabilitation.Br Heart J. 1992; 67: 412-418Crossref PubMed Scopus (92) Google Scholar requires a multifactorial approach to the many changes in attitude, affect, and behaviour required for improved quality of life and secondary prevention. The studies above focusing on one factor only serve to demonstrate the need for this broader approach. The Montreal study1Frasure-Smith N Lesperance F Prince RH et al.Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction.Lancet. 1997; 350: 473-479Summary Full Text Full Text PDF PubMed Scopus (419) Google Scholar also raises the issue of feasibility of service provision: even if the study showed beneficial effects, the provision of an average five to six home visits to more than three-quarters of a cardiac population must surely be reconsidered with a view to more efficient methods of delivering this service—eg, group and hospital-based or health-care-based methods? Frasure-Smith and colleagues provide a useful caution in that services with intuitive appeal (p 478), such as psychosocial intervention after coronary events, are not demonstrably beneficial in all settings. We wish to further caution that the message “home-based psychosocial nursing intervention alone following coronary events is ineffective” does not incorrectly become abbreviated to “psychosocial interventions after cardiac events are ineffective”. Cardiac rehabilitationAuthors' reply Full-Text PDF