Long-term effects of in-hospital cardiac rehabilitation on the cardiac risk profile - A case-control study in pairs of siblings with myocardial infarction

Aims In the general population, measures for secondary prevention of myocar dial infarction are poorly utilized. Our aim was therefore to analyse wheth er post-myocardial infarction in-hospital rehabilitation and education prog rammes improve the subsequent utilization of preventive strategies. Methods and Results We screened 93 500 patient charts in cardiac rehabilita tion clinics to identify a myocardial infarction patient with a sibling, wh o likewise had a myocardial infarction prior to the age of 60 years but was discordant with respect to the participation in cardiac in-hospital rehabi litation. In 92 such sibling pairs the coronary risk profile was studied by standardized questionnaire, biochemical measurements and physical examinat ion. At the time of the acute myocardial infarction, both groups showed an equal risk factor distribution. However. at follow-up ton average 5.5 years after myocardial infarction). rehabilitation-siblings presented with signi ficantly lower systolic (137+/-2 vs 150+/-3 mmHg. P<0.01) and diastolic blo od pressure (82 +/- 1 vs 89 +/- 1 mmHg. P<0.01). Antihypertensive drug ther apy resulted more often in effective (less than or equal to 140/90 mmHg) co ntrol of blood pressure (58% vs 29%, P<0.01). Blood lipid levels and smokin g prevalence tended to be lower in rehabilitation-siblings. Significantly f ewer rehabilitation-siblings presented with two or more modifiable risk fac tors (OR 0.36 (CI 0.17-0.76): P<0.01). There was a strong tendency towards fewer recurrent cardiac events: (re-myocardial infarction, coronary angiopl asty, coronary artery bypass grafting) during follow-up in rehabilitation-s iblings (OR 0.57 (CI 0.31-1.04); P= 0.07). Conclusion An in-hospital programme for cardiac rehabilitation may successf ully encourage therapy to modify risk factors and thus enhance the long-ter m implementation of secondary prevention.