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Community approach in rehabilitation and secondary prevention after acute myocardial infarction: results of a randomized clinical trial
Hamalainen H, Kallio V, Knuts L-R, Arstila M, Aalto S, L, Harmala V, Kaarsalo E, Laurila S, Pere E
Journal of Cardiopulmonary Rehabilitation 1991 Jul;11(4):221-226
clinical trial
3/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

The effects of a rehabilitation course in a rehabilitation center were compared to those in a community-based rehabilitation program after first acute myocardial infarction. Four hundred fifty-six patients under 65 years of age were randomized at discharge from hospital either to a hospital outpatient clinic group combined with a community-based rehabilitation program (O group, n = 228), or to a residential rehabilitation program (R group, n = 228). The coronary mortality during the 6-year follow-up was 24.1% in the O group, compared to 19.7% in the R group (NS). The nonfatal reinfarction rate was 11.8% in the O group and 13.6% in the R group (NS). The changes in serum total cholesterol and triglycerides were more favorable only during the first 3 months in R group compared to O group. At follow-up there were no differences between the groups in physical working capacity or return to work. Thus, the community-based rehabilitation program combined with regular outpatient check-ups was comparable with residential rehabilitation with regard to mortality and morbidity, although there was a tendency towards lower lifestyle-related risk factor levels in patients receiving residential rehabilitation.
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