Secondary prevention in patients several years after myocardial infarction: comparison of an outpatient and an inpatient rehabilitation programme

Objective To compare the effectiveness of secondary preventive measures in patients after myocardial infarction participating in an outpatient rehabil itation programme at a university hospital with those of an inpatient progr amme in community hospitals. Design Cross-sectional study of patients several years after myocardial inf arction. Methods Seven hundred patients who survived myocardial infarction in the pe riod from 1 January 1989 to 31 December 1995 were chosen from archives of t he university hospital (350 patients) and from archives of two community ho spitals (350 patients). The patients from the university hospital attended an outpatient rehabilitation programme, while the patients from the communi ty hospitals attended an inpatient rehabilitation programme. The data were obtained by questionnaire, clinical examination and laboratory blood analys es. Results One hundred and eighty patients attending an outpatient and 140 pat ients attending an inpatient rehabilitation programme responded to the invi tation. Among those who were smokers at the time of myocardial infarction, 91% of patients from the outpatient programme versus 77% of patients from t he inpatient programme (P < 0.05) gave up smoking and were still non-smoker s; 69% versus 48% (P < 0.05) had a lipid-modified diet; 21% versus 36% (P < 0.05) were obese (BIWI > 30 kg/m(2)). Blood pressure > 140/90 mmHg was fou nd in 21% versus 58% (P < 0.05); total cholesterol > 5.0 mmol/l in 67% vers us 87% (P < 0.05); and fasting glucose > 5.6 mmol/l in 43% versus 63% (P < 0.05) of patients from the outpatient and the inpatient programmes, respect ively. Among prophylactic drug treatments higher usage of beta-blocking age nts (56% versus 36%; P < 0.05) and lipolytic agents (43% versus 23%; P < 0. 05) and no significant difference in usage of antiplatelet drugs (83% versu s 75%) and angiotensin-converting enzyme inhibitors (30% versus 32%) was fo und in patients from the outpatient programme compared to patients from the inpatient programme. Only regular physical activity was performed better b y patients from the inpatient programme than by patients from the outpatien t programme (68% versus 50%; P < 0.05). Conclusions The outpatient rehabilitation programme of the university hospi tal resulted in better application of secondary prevention than the inpatie nt rehabilitation programme of community hospitals. (C) 2001 Lippincott Wil liams & Wilkins.