Rehabilitation after heart attack

Should be more flexible, and integrated with cardiac aftercare and primary care

Psychological complications are common after myocardial infarction and can substantially increase the use of healthcare resources. At least a quarter of patients suffer clinically important problems, including distress for patients and families, psychologically determined effects on quality of life, and increased mortality in those who are depressed. Awareness of the size of the problem, and the need to encourage changes in lifestyle for secondary prevention, has led to the growth of rehabilitation programmes. These are usually separate from cardiological care, hospital based, and with a standard format of exercise training and didactic education. Despite the enthusiasm of therapists and patients, doubts remain about efficacy and delivery.

Few current programmes have specifically designed psychological components, but a recent review concluded that “the addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress and some biological risk factors.”1 However, most published research has evaluated rather prolonged, elaborate interventions with selected …