Cardiac risk factors, medication, and recurrent clinical events after acute coronary disease - A prospective cohort study

Aims Systematic data are sparse on clinical outcome after acute coronary di sease followed by cardiac rehabilitation therapy. Therefore. our objective was to determine the long-term development of cardiac risk factors, recurre nt clinical events. and cardiac medication in patients undergoing routine i n hospital cardiac rehabilitation therapy. Methods and Results In the prospective PIN Study (Post Infarct Care). 2441 consecutive patients (78% men. 60 +/- 10 years, 22% women, 65 +/- 10 years) were enrolled in 18 inpatient rehabilitation centres in Germany following myocardial infarction (56%). coronary artery bypass graft (38%) or percutan eous transluminal coronary angioplasty (6%). Cardiac risk factors. pre-spec ified clinical end-points, and the prescription of cardiac medication were prospectively documented on admission to and at discharge from rehabilitati on therapy. and 3, 6 and 12 months later by obtaining information with stan dardized questionnaires from the patients and their physicians. The cardiac risk factors improved initially during cardiac rehabilitation therapy, but deteriorated within the following 12 months: 39% patients smoked at the be ginning vs 5% the end of in hospital rehabilitation vs 10%, at 12 months fo llow-up (P < 0.001). The respective numbers for patients with blood pressur e >140 and/or 90 mmHg were 24 vs 8 vs 25% (P < 0.01) and with plasma choles terul >200 mg.dl(-1) 57 vs 29 vs 51% (P < 0.01). A total of 886 patients ex perienced one or more recurrent clinical events during the first year, 69% of those within the initial 6 months. At 12 months followup. 77% of patient s received aspirin. 70% beta-blockers, 62%, lipid lowering medication, and 53% angiotensin converting enzyme inhibitors. Conclusion The present results indicate that the benefit of cardiac rehabil itation therapy following acute coronary events is only partially maintaine d during the following year, Continuous strategies of medical care need to be developed to improve the long-term outcome in coronary patients. (Eur He art J 2001; 22: 307-313, doi:10.1053/euhj.2000.2294) (C) 2001 The European Society of Cardiology.