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Long term cardiac rehab program may reduce CV risk after MI

Arch Internal Med 2008; 168: 2194–2204

Researchers have found that a comprehensive secondary prevention program lasting up to 3 years after myocardial infarction (MI) appears to reduce the risk for a second nonfatal MI and improve lifestyle habits and continuation of medication.

Current cardiac rehabilitation programs (CRPs) after heart disease rely on short-term interventions that are “unlikely to yield long-term benefits” and which fail to adequately prevent discontinuation of medication, say Pantaleo Giannuzzi (Istituto di Ricovero e Cura a Carattere Scientifico, Veruno, Italy) and team in the Archives of Internal Medicine.

The Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction (GOSPEL) study randomly assigned 1620 patients who had suffered an MI to receive a long-term, reinforced, multifactorial educational and behavioral intervention after a standard period of rehabilitation.

“The intervention was aimed at individualizing risk factor and lifestyle management, and pharmacological treatments were based on current guidelines,” explains the team.

Comprehensive sessions with one-on-one support were held monthly for 6 months, then once every 6 months for 3 years. Outcomes of patients in this program were compared with those of 1621 who were randomly assigned to receive usual care.

Overall, 556 (17.2%) patients experienced a cardiovascular event. There was no significant reduction in risk for combined heart events, at 16.1% of patients in the intervention group compared with 18.2% in the usual care group, with a hazard ratio (HR) of 0.88. But there was a significant decrease in incidence of individual coronary events and some combinations of outcomes, including a 48% reduction in nonfatal MI (1.4% vs 2.7%, HR=0.52).

“A marked improvement in lifestyle habits (ie, exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group,” the authors write.

They conclude: “After 3 years, the integrated, multifactorial, reinforced approach proved effective in countering the risk factors and medication adherence deterioration over time and was able to induce a considerable improvement in lifestyle habits.”

Read the abstract