Role of smokers in the household and of cardiac rehabilitation in smoking behaviour after acute myocardial infarction.

OBJECTS: This study aims to evaluate the influence of household smokers and of a prolonged, comprehensive home-based Cardiac Rehabilitation Program (CRP) on patient's long term smoking behaviour after AMI. METHODS: 164 male post-AMI patients, all smokers until the day of AMI, were subdivided into three groups: Group A (n=54): patients with recent AMI, discharged from hospital without enrolment in CRP; Group B (n=55): similar to Group A but enrolled in an 8 weeks hospital-based CRP and then discharged home with routine care; Group C (n=55) enrolled in an 8 weeks hospital-based CRP followed by a further 10 months of formal home-based CRP, with scheduled hospital follow-up visits. RESULTS: Smoking resumption at 12 months was influenced by the presence of household smokers (HS): 38% of patients with HS resumed smoking compared to 27% of patients without HS (p <0.01). Adherence to a CRP was inversely correlated to smoking resumption: there were fewer smoking patients at 12 months from AMI in Group C than in Groups A or B (11% in C vs. 29% and 55% in B and A, respectively, p <0.001). CONCLUSIONS: Long term maintenance of CRP seems to be the best way to achieve a reduction of long term smoking habit and maintain adherence to prescription in patients after AMI. Counselling and behavioural intervention should also be extended to family members in order to maximize the benefit of secondary prevention.

[Cardiac rehabilitation in a HIV-patient treated with protease inhibitors]. / Riabilitazione Cardiologica in paziente HIV-positivo trattato con inibitori di proteasi.

We report a case of a 38-years-old HIV-positive patient, undergoing in the last 18 months therapy with three antiretroviral drugs including a protease inhibitor (nelfinavir). The patient was admitted in our Department with acute anterior myocardial infarction and was submitted to PTCA on the left anterior descending coronary artery. The patient, a 30 cigarettes/day smoker, with family history of hypertension and high levels of trygliceride and cholesterol, was subsequently admitted to our Cardiac Rehabilitation Unit. Cardiac Rehabilitation Program was composed of cycle aerobic training 4 times/week, dietary education, psychologic support and therapy with pravastatin, aspirin, nitrate, enalapril, and carvedilol. At the end of the 8 week Rehabilitation Program we observed a normalization of cholesterol and trygliceride levels and an improvement of cardiac functional capacity and mental health.