Early Mobilization and Discharge of Patients with Acute Myocardial Infarction

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Abstract
Consecutive patients (n [number] = 184) surviving 48 h in a coronary care unit were divided into 1 rapidly (RM) (n = 55, 30%) and 1 conventionally mobilized (CM) group (n = 129, 70%). The selection of RM patients was based on the presence of 5 early risk indicators (RI), reflecting electrical and mechanical heart dysfunction. During after-care 5 late RI were evaluated, including a submaximal bicycle exercise test to 50 W [work unit], which excluded 9 (16%) additional patients from the RM group. After exluding 4 patients for non-cardiac reasons the remaining 42 RM patients were rapidly mobilized and discharged after a mean of 9 days, in contrast to a mean of 19 days in the CM group, comprising 121 patients. No RM patient died in hospital and only 1 patient died during a 6 mo. follow-up, compared to 17 (P < 0.01) and 28 (P < 0.01) patients, respecitvely, in the CM group. Reinfarction and mortality increased with the number of positive RI. The early exercise test excluded 4 patients from the RM group. Of 45 pateints, 22 showed some abnormality during exercise. Half of these 22 patients were readmitted due to cardiac complications during the follow-up period. Apparently it is possible to identify a group of patients with AMI suitable for early discharge, and an early exercise test in selected good risk patients is safe and identifies a group prone to complications during the early follow-up period.