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J Am Coll Cardiol, 2005; 45:1909, doi:10.1016/j.jacc.2005.03.009
© 2005 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Cardiac Rehabilitation Following Myocardial Infarction

Robert R. West, MA, PhD, FSS, FFPHM*

* Wales Heart Research Institute, Heath Park, Cardiff, CF14 4XN Wales, United Kingdom (Email: WestRR{at}cardiff.ac.uk).

In an observational study Witt et al. (1) report a striking survival advantage among patients attending cardiac rehabilitation. They employ a rather unusual adjustment to compare patients of very different ages, a "propensity to attend cardiac rehabilitation" rather than the more usual inclusion of prognostic risk factors in multivariate analyses.

Their findings are not borne out by randomized trials. In discussion, they comment that early (small) trials may not be generalized to contemporary practice. Too true. Pooling of all trials undertaken since the World Health Organization European collaborative (but excluding ours, see the next sentence) show collectively no significant effect on mortality (2). The only multicenter trial undertaken since widespread use of thrombolysis, aspirin, beta-blocker, angiotensin-converting enzyme inhibitor, and statin shows no effect on mortality (3).


   References
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  1. Witt BJ, Jacobsen SJ, Weston SA, et al. Cardiac rehabilitation after myocardial infarction in the community J Am Coll Cardiol 2004;44:988-996.[Abstract/Free Full Text]
  2. West RR. Cardiac rehabilitationto reduce mortality and morbidity or to improve quality of medical care. Eur J Cardiovasc Prev Rehab 2004;11(Suppl 1):87.[CrossRef]
  3. West RR, Beswick AD. Mortality, morbidity and quality of life following cardiac rehabilitationresults of multicentre randomised controlled trial. J Am Coll Cardiol 2002;39(Suppl B):453B.

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Brandi J. Witt, Steven J. Jacobsen, and Véronique L. Roger
J. Am. Coll. Cardiol. 2005 45: 1909-1910. [Full Text] [PDF]




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