Article type
Year
Abstract
Objective: The aim of this study was to determine whether there is evidence for fotff the clinical impact of bed rest after uncomplicated myocardial infarction. Growing economic pressure has led to short period bed rest recommendations (12-hour) in the guidelines of leading cardiology associations (European Society of Cardiology, American Heart Association and the American College of Cardiology). These recommendations seem to be more consensus-based than evidence-based.
Methods: We performed a systematic review looking at randomised and quasi-randomised controlled trials. Studies were eligible if patients met predefined criteria of an uncomplicated myocardial infarction. The intervention looked for was bed rest and patients had to be allocated to a period of either short or prolong bed rest and the main outcome measures had to be reported in absolute numbers. We searched MEDLINE (1966-12/2001), EMBASE (1988-11/2001), Evidence Based Medicine 1974-9/2001, PASCAL BioMed (1996-10/2001) and Psych Info (1966-12/2001) using Winspirs and we searched the Cochrane Controlled Trial Register. Predefined search terms were used. We also looked trough relevant textbooks published after 1985 and papers selected from relevant references. There was no language restriction. The main outcome measures were mortality, reinfarction, angina pectoris or thromboembolic events. Two reviewers extracted data independently and disagreement was solved by discussion. A funnel plot was drawn to check for publication bias.
Results: 5 randomised and 10 quasi-randomised trials were included. The majority of these trials were published in the 1970s, the latest being published in 1989. There was a short bed rest group (2 to 12 days) with 1332 patients and a prolonged bed rest group (5 to 28 days) with 1326 patients. Mortality, reinfarction, angina pectoris or thromboembolic events were comparable between studies with a longer period of bed rest versus short bed rest. Study quality was generally unsatisfactorily (10 trials only quasi-randomised, only 3 mentioned blinded assessment of outcome and only 1 explicitly mentioned intention-to-treat analysis). The trials were underpowered to detect clinically meaningful differences. Publication bias was not very likely. We did not combine the results quantitatively as there was clinical heterogeneity in terms of duration of bed rest.
Conclusions: The evidence we found is not sufficient to inform clinical practice: the study quality was generally poor and treatment of acute myocardial infarction since publication of the latest trial has changed immensely. Thus it is unclear if bed rest after uncomplicated myocardial infarction helps to prevent complications such as early mortality and reinfarction.
Methods: We performed a systematic review looking at randomised and quasi-randomised controlled trials. Studies were eligible if patients met predefined criteria of an uncomplicated myocardial infarction. The intervention looked for was bed rest and patients had to be allocated to a period of either short or prolong bed rest and the main outcome measures had to be reported in absolute numbers. We searched MEDLINE (1966-12/2001), EMBASE (1988-11/2001), Evidence Based Medicine 1974-9/2001, PASCAL BioMed (1996-10/2001) and Psych Info (1966-12/2001) using Winspirs and we searched the Cochrane Controlled Trial Register. Predefined search terms were used. We also looked trough relevant textbooks published after 1985 and papers selected from relevant references. There was no language restriction. The main outcome measures were mortality, reinfarction, angina pectoris or thromboembolic events. Two reviewers extracted data independently and disagreement was solved by discussion. A funnel plot was drawn to check for publication bias.
Results: 5 randomised and 10 quasi-randomised trials were included. The majority of these trials were published in the 1970s, the latest being published in 1989. There was a short bed rest group (2 to 12 days) with 1332 patients and a prolonged bed rest group (5 to 28 days) with 1326 patients. Mortality, reinfarction, angina pectoris or thromboembolic events were comparable between studies with a longer period of bed rest versus short bed rest. Study quality was generally unsatisfactorily (10 trials only quasi-randomised, only 3 mentioned blinded assessment of outcome and only 1 explicitly mentioned intention-to-treat analysis). The trials were underpowered to detect clinically meaningful differences. Publication bias was not very likely. We did not combine the results quantitatively as there was clinical heterogeneity in terms of duration of bed rest.
Conclusions: The evidence we found is not sufficient to inform clinical practice: the study quality was generally poor and treatment of acute myocardial infarction since publication of the latest trial has changed immensely. Thus it is unclear if bed rest after uncomplicated myocardial infarction helps to prevent complications such as early mortality and reinfarction.