Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial

Abstract

Objective : To evaluate rehabilitation after myocardial infarction. Design : Randomised controlled trial of rehabilitation in unselected myocardial infarction patients in six centres, baseline data being collected on admission and by structured interview (of patients and spouses) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months. Setting : Six district general hospitals. Subjects : All 2328 eligible patients admitted over two years with confirmed myocardial infarction and discharged home within 28 days. Interventions : Rehabilitation programmes comprising psychological therapy, counselling, relaxation training, and stress management training over seven weekly group outpatient sessions for patients and spouses. Main outcome measures : Anxiety, depression, quality of life, morbidity, use of medication, and mortality. Results : At six months there were no significant differences between rehabilitation patients and controls in reported anxiety (prevalence 33%) or depression (19%). Rehabilitation patients reported a lower frequency of angina (median three versus four episodes a week), medication, and physical activity. At 12 months there were no differences in clinical complications, clinical sequelae, or mortality. Conclusions : Rehabilitation programmes based on psychological therapy, counselling, relaxation training, and stress management seem to offer little objective benefit to patients who have experienced myocardial infarction compared with previous reports of smaller trials. Key messages: In this series there were no important differences by age, sex, hospital, or baseline anxiety or depression At six months the prevalence rates of clinical anxiety and depression remained high (33% and 19% respectively) Patients and spouses rated programmes highly, which suggests a “quality of care” role for rehabilitation