Myocardial infarction: cardiac rehabilitation decreases death.

Clinical bottom line (level 1a)

  1. Patients who have had a myocardial infarction and are given cardiac rehabilitation are less likely to die from any cause, than those given no rehabilitation (NNT = 30 at unknown) .
  2. Patients given cardiac rehabilitation are less likely to suffer a cardiovascular death (NNT = 35 at unknown) .
Oldridge et al: Journal of the American Medical Association 1988; 260 (7): 945-950
Expires March 2003

The study

Systematic review of randomised controlled trials of
  • Patients: myocardial infarction
  • Intervention: cardiac rehabilitation compared with no cardiac rehabilitation
  • Outcome: mortality



Articles found in English using MEDLINE, ? dates (search terms: myocardial infarction, rehabilitation, risk factor, exercise, mortality and morbidity ) and review of relevant English language publications and by canvassing 18 experienced cardiac rehabilitation colleagues for knowledge of published and unpublished data.

Selection criteria: as above
Appraisal criteria: detailed in text
Articles excluded if: Follow-up less than 24 months, allocation of patients into groups according to time of enrolment, and randomisation of patients from one hospital to rehabilitation and from another to control group.

Ten trials involving 4347 patients were included.
No statistically significant heterogeneity was found.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
all-cause mortality unknown 289/
(16.1%)		 0.76
(0.63 to 0.92) 		30
(19 to 91)
cardiovascular death unknown 252/
(12.6%)		 0.75
(0.62 to 0.93) 		35
(23 to 129)

Citation

  1. Oldridge NB, Guyatt GH, Fischer ME, et al: Cardiac rehabilitation after myocardial infarction: Combined experience of randomized clinical trials. Journal of the American Medical Association 1988; 260 (7): 945-950
Contributor: Clare Wotton and Bob Phillips, January 2000
Reviewer:

Clinical Question.
Patient myocardial infarction
Intervention or Exposure cardiac rehabilitation
Comparison no cardiac rehabilitation
Outcome mortality