Effects of in-hospital rehabilitation on cardiovascular risk factors in patients with coronary heart disease

Background and objective: The prognostically favourable effect of secondary prevention in patients with proven coronary heart disease (CHD: documented myocardial infarction, angiographically proven coronary artery stenosis >6 0% and/[or] status after coronary artery surgery) has been demonstrated. Bu t it has not been adequately shown to what extent the guidelines laid down by specialist societies is being followed in routine clinical practice. Nor have there been any large-size standardized investigations of whether in-h ospital rehabilitation decreases cardiovascular risk factors. It was the ai m of this study to investigate the acute effects on cardiovascular risk fac tors of in-hospital post-infarction rehabilitation. Patients and methods: From January to May 1997, at 18 rehabilitation clinic s, 2441 consecutive patients (22% women, aged 65 +/- 10 years, 78% men, age d 60 +/- 10 years) with proven CHD were included in this post-infarction af ter-care (PIN) study. During their hospital stay (26 +/- 5 days) they under took physical training appropriate for cardiological follow-up treatment, a s well as various other modes of treatment to affect risk factors. Diagnosi s, treatment and standardized data were prospectively recorded on admission and discharge. Results: At discharge the proportions of patients with conventionally defin ed risk factors were significantly lower than on admission (P < 0.001). The proportion was 8% in patients with arterial blood pressure >140/90 mm Hg ( vs. 24% on admission), 5% in smokers (vs. 39% on admission), 30% vs. 60% in patients with cholesterol levels > 200 mg/dl, 67% vs. 87% in those with lo w density lipids > 100 mg/dl, 15% vs. 22%, in those with serum triglyceride levels > 200 mg/dl, 11% vs. 14% in those with glucose levels > 140 mg/dl, and 15% vs. 18% in patient with a body/mass index > 30 kg/m(2). There was a n increase in the proportion of patients who during their hospital stay wer e prescribed additional drugs: from 85% to 86% for acetylsalicylic acid (P < 0.05), 61% to 77% for beta-adrenergic receptor blockers, 33% to 67% for c holesterol synthesis enzyme (CSE) inhibitors, and 51% to 57% for angiotensi n converting enzyme (ACE) inhibitors. Conclusion: Modifiable cardiovascular risk factors can be reduced by variou s methods of rehabilitation and more intensive drug treatment during hospit alization. By taking account of evidence-based medicine favourable conditio ns can be created for longterm ambulant after-care.