Cardiac risk factors, medication, and recurrent clinical events after acute coronary disease. A prospective cohort study

Abstract

Aims Systematic data are sparse on clinical outcome after acute coronary disease followed by cardiac rehabilitation therapy. Therefore, our objective was to determine the long-term development of cardiac risk factors, recurrent clinical events, and cardiac medication in patients undergoing routine inhospital cardiac rehabilitation therapy.

Methods and Results In the prospective PIN Study (Post Infarct Care), 2441 consecutive patients (78% men, 60±10 years, 22% women, 65±10 years) were enrolled in 18 inpatient rehabilitation centres in Germany following myocardial infarction (56%), coronary artery bypass graft (38%) or percutaneous transluminal coronary angioplasty (6%). Cardiac risk factors, pre-specified clinical end-points, and the prescription of cardiac medication were prospectively documented on admission to and at discharge from rehabilitation therapy, and 3, 6 and 12 months later by obtaining information with standardized questionnaires from the patients and their physicians. The cardiac risk factors improved initially during cardiac rehabilitation therapy, but deteriorated within the following 12 months: 39% patients smoked at the beginning vs 5% at the end of inhospital rehabilitation vs 10% at 12 months follow-up (P<0·001). The respective numbers for patients with blood pressure >140 and/or 90mmHg were 24 vs 8 vs 25% (P<0·01) and with plasma cholesterol >200mg.dl⁻¹57 vs 29 vs 51% (P<0·01). A total of 886 patients experienced one or more recurrent clinical events during the first year, 69% of those within the initial 6 months. At 12 months follow-up, 77% of patients received aspirin, 70% beta-blockers, 62% lipid lowering medication, and 53% angiotensin converting enzyme inhibitors.

Conclusion The present results indicate that the benefit of cardiac rehabilitation therapy following acute coronary events is only partially maintained during the following year. Continuous strategies of medical care need to be developed to improve the long-term outcome in coronary patients.

Coronary heart disease, rehabilitation, secondary prevention, risk factors

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Correspondence: Prof. Stefan N. Willich, Institute for Social Medicine and Epidemiology, Charité Hospital, Humboldt University of Berlin, 10098 Berlin, Germany.