Rapid mobilisation after acute myocardial infarction. First step in rehabilitation and secondary prevention

Abstract

Rapid mobilization after acute myocardial infarction as the first step in a planned program of rehabilitation and secondary prevention was studied in a group of 142 men under 65 yr of age admitted to a coronary care unit. Patients without complications were mobilized after 2 days' bed rest, but the program was flexible and those with complications were mobilized less rapidly. Fifteen patients died before mobilization could be started. In 127 who survived long enough to be mobilized, 74 (58%) spent 2 to 4 days in bed, 42 (33%) 5 to 10 days, and 11 (9%) more than 10 days. The mean period of bed rest was 5.4 days. Rapid mobilization eliminated the need for the physiotherapy and led to early discharge from hospital with more economic use of hospital beds. In 125 patients who were discharged, 99 (79%) had 16 days or less (5 to 16) in hospital. The mean period of hospital stay was 15.5 days. A program of progressive rehabilitation with advice on secondary prevention, which was started in hospital, was continued at a convalescent hospital with graded exercises supervised by physiotherapists. This allayed anxiety and led to a more confident return home. A community nurse visited the home to reinforce advice given in hospital to the patient and his wife and extend primary prevention to the family. Review was undertaken at a special clinic to ensure the safety of the program and to give further reassurance and advice about early return to work, exercise, and secondary prevention. Cardiac neurosis was thereby virtually prevented. In 105 eligible for employment, 46% had returned to work within 12 wk and 86% within 24 wk, of whom 90% returned to their former employment. In 127 patients who had been mobilized, 3 (2.5%) died within 6 wk, and a further 8 (6.5%) had various nonfatal cardiac complications, but none of the 74 mobilized rapidly after 2 to 4 days died within this period. Only 1 was readmitted within 4 wk. In view of this and other reported experiences it is clear that rapid mobilization and early discharge after myocardial infarction should now be standard practice and there is no need of further evidence of its safety.