EFFECTS OF EARLY REHABILITATION ON CONSUMPTION OF MEDICAL-CARE DURING THE FIRST YEAR AFTER ACUTE MYOCARDIAL-INFARCTION IN PATIENTS GREATER-THAN-OR-EQUAL-TO-65 YEARS OF AGE

A rehabilitation program that relied totally upon tire primary health care system was created in Goteborg, Sweden, for patients greater than or equal to 65 years old with acute myocardial infarction. Patients from one primary health core district were assigned to a rehabilitation program (n = 91), while patients from a neighboring district constituted a control group (n = 99), The rehabilitation measures were initiated very early after the infarction with individual counseling in the home of the patient and later In the local health center, where 21% of the patients also joined a low-intensity exercise group. The control group was somewhat older and contained a greater number of women compared with the rehabilitation group, but sire and course of infarction, complications, and previous morbidity were similar, To control for differences in age, a matching procedure was performed and 71 pairs of the same sex and age were found, During the first 3 months there wets a significantly lower incidence of rehospitalization in the intervention group, regarding both percentage of patients (p < 0.04) and days of rehospitalization (p = 0.05), Visits to the emergency department without rehospitalization were also significantly lower in the intervention group (p = 0.005), After 12 months the differences still remained, with the exception of days of rehospitalization. In the matched groups the same result was seen. While readmissions and emergency department visits generally were well justified in the intervention group, vague symptoms dominated among the controls, The factor that was most strongly related to readmissions in the intervention group was previous infarction (p < 0.0001), while in the control group no special factor influencing readmissions could be found. Thus, an uncomplicated rehabilitation model characterized by very early intervention and performed within the primary health care system can significantly reduce the consumption of health care 1 year after myocardial infarction in patents greater than or equal to 65 years old.