It is well recognised that phase 3 cardiac rehabilitation is beneficial, reducing both mortality and morbidity following acute myocardial infarction. The role of ongoing phase 4 cardiac rehabilitation is less clear. This study was designed to assess the effectiveness of phase 4 cardiac rehabilitation in acute myocardial infarction.
Following acute myocardial infarction, 143 patients who had completed phase 3 cardiac rehabilitation were followed up. Analysis was divided into three groups: those who took up phase 4 rehabilitation, those offered who declined and those not offered phase 4 rehabilitation because it was not available locally. Risk factor profile, self-reported exercise and quality-of-life scores using the short form (SF)-36 were assessed in all patients.
Body mass index (BMI) shows no overall change in the ‘accepted’ group, but shows a significant increase between pre and five-year levels in the ‘declined’ group (p=0.024) and in the ‘not offered’ group (p=0.014). All groups showed an increase of SF-36 scores following phase 3, which showed a trend towards significance. Both the ‘accepted’ and ‘not offered’ groups maintained this improvement, while the ‘declined’ group returned to baseline (p=0.05 vs. ‘accepted’ and p=0.03 vs. ‘not offered’). All groups had similar exercise levels initially and all showed significant improvements after phase 3 with some deterioration out to five years. This decline in exercise was significant in the ‘declined’ group (p=0.029) and shows a trend in the ‘not offered’ group (p=0.057).
This small single-centre study suggests that there are observable benefits in participating in long-term phase 4 cardiac rehabilitation. Those who decline phase 4 cardiac rehabilitation clearly do less well. Whether the benefits seen can be attributed directly to phase 4 cardiac rehabilitation would require a different study design to address this issue.