Kinga Balla; Karl Konstantin Haase

doi:10.19080/JOJPH.2024.09.555758

Mini Review

Is There an Up-To-Date Evidence-Based Myocardial Infarction Therapy Model in Acute Phase of Rehabilitation?

**Kinga Balla*, Karl Konstantin Haase**

Kreiskliniken Reutlingen GmbH, Steinenberg Str 31,72764 Reutlingen, Germany

Submission: June 26, 2024; Published: August 12, 2024

*Corresponding author: Kinga Balla, Kreiskliniken Reutlingen GmbH, Steinenberg Str 31,72764 Reutlingen, Germany. Email: kinga.balla@kliniken-rt.de

How to cite this article:Kinga Balla*, Karl Konstantin Haase. Is There an Up-To-Date Evidence-Based Myocardial Infarction Therapy Model in Acute Phase of Rehabilitation?. 2024; 9(2): 555758. DOI: 10.19080/JOJPH.2024.09.555758

Keywords: Acute Myocardial Infarction; Reutlingen Myocardial Infarction Therapy Model; Physiotherapy; Rehabilitation; Mobilization plan

Introduction

Acute myocardial infarction (MI) is one of the leading causes of morbidity and mortality in the world [1]. The global prevalence of myocardial infarction (sample size N=35 million), for < 60 years individuals was detected to be 3.8% and for ≥ 60 years 9.5% [1], representing in total three million people worldwide [2]. An acute MI may lead to irreversible damage to the heart muscle due to a lack of oxygen caused by decreased coronary blood flow: available oxygen supply cannot meet oxygen demand. Associated symptoms include [3-4] chest pain or pressure, shoulder or arm pain, sweating, shortness of breath, nausea, anxiety, etc. Myocardial ischemia may be associated with ECG changes and elevated biochemical markers such as cardiac troponins [5]. The pathology is divided into two categories: MI with ST-elevation (STE-MI) and non-ST elevation MI (NSTE-MI). The best-known modifiable risk factors for coronary artery disease are [6]: smoking, abnormal lipid profile, hypertension, diabetes mellitus, adipositas, lack of physical activity, psychosocial factors such as depression [7] etc. The primary treatment form for MI is the percutaneous coronary intervention (PCI), which enables the reperfusion of the heart and restores the blood flow [2]. An early PCI treatment is the key to a good prognosis and cardiac rehabilitation.

The rehabilitation process is divided into three phases [8]. The first phase is the clinical phase, which begins with the in-hospital setting after intervention (PCI). Phase II is outpatient cardiac rehabilitation, which commences about the third week after PCI and lasts three to four weeks. In the third phase or post-cardiac rehabilitation, patients receive encouragement to maintain an active lifestyle and continue the exercises. The period of the first phase (clinical) is the most vital phase of cardiac rehabilitation [8-9]. Haykowsky et al. [10] conducted a meta-analysis and found that delaying the start of training leads to a poorer baseline situation in terms of left ventricular function. This confirms the need for daily therapy immediately after MI [11-12]. Although phase I is recognized as the most important phase in MI rehabilitation [8-13] and evidence-based studies are available [3-12], myocardial infarction mobilization plans can hardly be found in the international or national literature [14-15] or are no longer up to date due to changing conditions [16-17], e.g. shortened hospital stay and therapy times. To close this gap, an evidence-based therapy model (Reutlingen Myocardial Infarction Therapy Model) was developed for MI patients in acute phase I of rehabilitation (hospitalization), so that we can provide our patients with the best possible care (Figure 1).

The Reutlingen Myocardial Infarction Therapy Model is based on the Heidelberg model [17], supplemented with two further methods known from literature, the 6-minute walk test (6MWT) and ergometer training. The 6 MWT is a wildly used, simple, low cost, validated submaximal exercise test to assess the daily activity performance by patients with heart diseases [18-19]. According to studies, ergometer training is an optimal form of therapy for MI patients from the second rehabilitation phase [20]. There are fewer studies on ergometer training [21] or motorized exercise training (MOTOmed [22]), in the first phase of rehabilitation. The ergometer test according to the Bruce protocol [23] as a resilience/stress test in the first MI phase has been tested as safe and efficient [24-25].