Papers by DrShahid Khalil
Cardiology, 1983
Randomized clinical trials of cardiac rehabilitation following myocardial infarction have typical... more Randomized clinical trials of cardiac rehabilitation following myocardial infarction have typically demonstrated a lower mortality in treated patients, but with a statistically significant reduction in only one trial. To overcome the problem of not being able to detect small but clinically important benefits in mortality in randomized clinical trials of exercise and risk factor rehabilitation after myocardial infarction with small numbers of patients, we carried out a meta-analysis on the combined results of ten randomized clinical trials that included 4347 patients (control, 2145 patients; rehabilitation, 2202 patients). The pooled odds ratios of 0.76 (95% confidence intervals, 0.63 to 0.92) for all-cause death and of 0.75 (95% confidence intervals, 0.62 to 0.93) for cardiovascular death were significantly lower in the rehabilitation group than in the control group, with no significant difference for nonfatal recurrent myocardial infarction. These results suggest that, for appropriately selected patients, comprehensive cardiac rehabilitation has a beneficial effect on mortality but not on nonfatal recurrent myocardial infarction. (JAMA 1988;260:945-950) CARDIAC rehabilitation can be de¬ fined as the "sum of activity required to ensure cardiac patients the best possi¬ ble physical, mental, and social condi¬ tions so that they may by their own efforts regain as normal as possible a place in the community and lead an ac¬ tive life."1 Major objectives of cardiac rehabilitation include not only an im¬ proved functional capacity and quality of life but also a reduction in mortality and morbidity. It is difficult to assess whether either a significant improve¬ ment in quality of life or a significant reduction in mortality or morbidity is present in trials with few patients or whether the effect is consistent across trials. As a result, patients may not be referred to cardiac rehabilitation after myocardial infarction, possibly because some clinicians consider that the overall benefits are not worth the costs and the patient's efforts. The results of the lim¬ ited number of published randomized clinical trials of exercise and risk factor management after myocardial infarc¬ tion with relatively small sample sizes have not confirmed a significant effect on mortality and morbidity,2'" although in some there is an improved exercise tolerance,2,4" risk factor profile,4"'9 and psychosocial status, at least in the short term.1516 If cardiac rehabilitation after myocardial infarction was demonstrat¬ ed to reduce mortality by 20% or more, it might be more likely to be considered an important component of secondary prevention of coronary heart disease with a potentially large socioeconomic impact.
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Papers by DrShahid Khalil