Public Health Rehabilition after Acute Myocardial Infarction: a Randomized Controlled Study
Background: Cardiovascular diseases (CVD) are the main causes of death worldwide. The incidence of and mortality from CVD in Kazakhstan is greater than in most neighboring countries warranting urgent public health measures related to both primary, secondary and tertiary prevention. Aims: To assess whether a newly developed 6-months public health rehabilitation program for patients with acute myocardial infarction (AMI) with home visits performed by physician assistants is superior to the standard rehabilitation of these patients in Western Kazakhstan. Methods: A randomized controlled study. A total of 75 AMI patients were enrolled after discharge form the hospital and 72 completed the trial. The control group (n = 34) participated in the standard rehabilitation program while the intervention group (n = 38) underwent and experimental rehabilitation program with home visits in addition to the standard program. Body mass index, waist circumference, blood pressure, heart rate, blood lipids, smoking and compliance to the treatment were assessed at the enrollment and after 6 months of the follow-up. Differences between the changes in the intervention and in the control group were compared using Mann-Whitney tests. Results: The experimental program was superior to the standard program in reducing systolic- (-22.5 vs. -2.9 mm Hg, p < 0.004) and diastolic (-6.3 vs. -0.6 mm Hg, p = 0.032) blood pressure, body mass index (-0.99 vs. 0.53 kg/m<sup>2</sup>, p < 0.001), waist circumference (-3.0 vs. 1.7 cm, p < 0.001) and the number of smoked cigarettes (-12 vs. -3, p = 0.002). Blood lipid profiles improved in both groups. Although slightly more pronounced changes were observed in the intervention group, the differences did not reach the level of statistical significance. Conclusions: The program was more effective on blood pressure, smoking and obesity-related indicators than the standard rehabilitation. Larger studies are warranted to corroborate our findings prior to implementation of the program in practice.