Standard cardiac rehabilitation is less effective for diabetics

To assess clinical outcomes and lifestyle modifications in diabetic patient s attending a standard cardiac rehabilitation programme following myocardia l infarction (MI), a retrospective longitudinal study was undertaken in a d istrict general hospital in the north west of England. A total of 1804 pati ents attended the cardiac rehabilitation programme over 10 years, of whom 2 23 (12.4%) had diabetes mellitus. Drugs were underprescribed in all patient s, aspirin and beta-blockers especially in diabetics (75.3% vs 90.3%, p <0. 0001; 38.6% vs 60.8%, p <0.0001). Smoking cessation was poor in diabetics ( 54.2% vs 69.1 %, p <0.003) and diabetics were less likely to attend at leas t one session of physiotherapy (26.9% vs 58.6%, p <0.0001). Diabetics had h igher mortality at one year (15.7% vs 5.6%; p <0.0001), mostly associated w ith cardiovascular disease (13.4% vs 5.4%, p <0.0001). Standard cardiac reh abilitation programmes appear to be less effective for patients with diabet es mellitus. We suggest that patients presenting with an existing chronic c ondition need specialised programmes of rehabilitation to integrate the car e of that condition with their recent Mi. Aggressive drug therapy following acute Mi should also be prescribed in all patients when not contraindicate d by other evidence.