Objective: To compare the effectiveness of secondary preventive measures in patients after myocardial infarction participating in an outpatient rehabilitation programme at a university hospital with those of an inpatient programme in community hospitals.
Design: Cross-sectional study of patients several years after myocardial infarction.
Methods: Seven hundred patients who survived myocardial infarction in the period from 1 January 1989 to 31 December 1995 were chosen from archives of the university hospital (350 patients) and from archives of two community hospitals (350 patients). The patients from the university hospital attended an outpatient rehabilitation programme, while the patients from the community hospitals attended an inpatient rehabilitation programme. The data were obtained by questionnaire, clinical examination and laboratory blood analyses.
Results: One hundred and eighty patients attending an outpatient and 140 patients attending an inpatient rehabilitation programme responded to the invitation. Among those who were smokers at the time of myocardial infarction, 91% of patients from the outpatient programme versus 77% of patients from the inpatient programme (P < 0.05) gave up smoking and were still non-smokers; 69% versus 48% (P < 0.05) had a lipid-modified diet; 21% versus 36% (P < 0.05) were obese (BMI > 30 kg/m2). Blood pressure > 140/90 mmHg was found in 21% versus 58% (P < 0.05); total cholesterol > 5.0 mmol/l in 67% versus 87% (P < 0.05); and fasting glucose > 5.6 mmol/l in 43% versus 63% (P < 0.05) of patients from the outpatient and the inpatient programmes, respectively. Among prophylactic drug treatments higher usage of beta-blocking agents (56% versus 36%; P < 0.05) and lipolytic agents (43% versus 23%; P < 0.05) and no significant difference in usage of antiplatelet drugs (83% versus 75%) and angiotensin-converting enzyme inhibitors (30% versus 32%) was found in patients from the outpatient programme compared to patients from the inpatient programme. Only regular physical activity was performed better by patients from the inpatient programme than by patients from the outpatient programme (68% versus 50%; P < 0.05).
Conclusions: The outpatient rehabilitation programme of the university hospital resulted in better application of secondary prevention than the inpatient rehabilitation programme of community hospitals.