Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

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Question 35 of 39:

Since this patient had an uncomplicated myocardial infarction he does not need to participate in a cardiac rehabilitation program.

You clicked 'True'

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Cardiac rehabilitation combines prescriptive exercise training with education about coronary risk factor modification techniques. Formal rehabilitation programs have been shown to effectively improve functional capacity, promote compliance, decrease emotional distress, improve quality of life, reduce cardiovascular mortality, mitigate ischemic symptoms, promote reversal of atherosclerosis, and reduce risk of subsequent coronary events. Cardiac rehabilitation may decrease denial, which is known to have a repressive effect and may discourage treatment compliance and recovery after discharge.

Despite these benefits, only 15% of qualified patients participate in cardiac rehabilitation, possibly because of lack of physician referral, poor motivation, logistical or financial constraints, or a combination of these factors. Home exercise training programs have been shown to be beneficial in certain low-risk patient groups. They offer the advantages of convenience and low cost but lack the valuable elements of education and group interaction.

Social integration and social support have been repeatedly shown to influence outcomes after acute MI. Social integration refers to existence of social ties (eg, spouse, close family members, or friends) and degree of participation in group activities (eg, family gatherings, religious affiliations). Social support refers to the actual or perceived receipt of information, materials, and/or emotional support.

Mortality from all causes, including ischemic heart disease, is lower in socially integrated individuals. Recurrent cardiac events are also significantly lower among persons reporting high levels of social integration when compared with socially isolated persons.

The most effective social support interventions occur naturally. Family members should be told the importance of their support, including the observation that the need for support has been shown to last longer than most family members realize. The quality of the support provided is key; support has been shown to facilitate treatment compliance but only when "policing'' is minimized. Telephone follow-up, cardiac rehabilitation, or other group events can be effective methods of support for socially isolated individuals.