Intervention Review

Bed rest for acute uncomplicated myocardial infarction

  1. Harald Herkner1,*,
  2. Jasmin Arrich1,
  3. Christof Havel2,
  4. Marcus Müllner3

Editorial Group: Cochrane Heart Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 11 OCT 2009

DOI: 10.1002/14651858.CD003836.pub2

Database Title

Additional Information

How to Cite

Herkner H, Arrich J, Havel C, Müllner M. Bed rest for acute uncomplicated myocardial infarction. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003836. DOI: 10.1002/14651858.CD003836.pub2.

Author Information

  1. 1

    Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria

  2. 2

    University of Vienna, Medical Faculty, Department of Emergency Medicine, Vienna, Austria

  3. 3

    Austrian Medicines and Medical Devices Agency, AGES PharmMed, Vienna, Austria

*Harald Herkner, Department of Emergency Medicine, Medical University of Vienna, Vienna General Hospital;, Währinger Gürtel 18-20 / 6D, Vienna, 1090, Austria. harald.herkner@meduniwien.ac.at.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 JAN 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Bed rest is prescribed to all patients with acute myocardial infarction (AMI), but to a variable extent. Current guidelines (American College of Cardiology/ American Heart Association) recommend at least 12 hours bed rest in patients with uncomplicated ST-elevation myocardial infarction, however the basis for this recommendation is unclear.

Objectives

To compare the effects of short versus longer bed rest in patients with uncomplicated AMI.

Search methods

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 3), MEDLINE (January 1966 to October 2009), EMBASE (January 1988 to October 2009), PASCAL BioMed (January 1996 to August 2005), PsycINFO (January 1966 to October 2009) and BIOSIS Previews (January 1990 to October 2009). Bibliographies were checked. No language restrictions were applied.

Selection criteria

Randomised and quasi-randomised controlled trials of short versus longer bed rest in patients with uncomplicated AMI were sought.

Data collection and analysis

Study selection was performed independently by at least two investigators according to the predefined inclusion criteria. Data were extracted by two investigators independently and in duplicate. Authors were contacted to obtain missing information.

Main results

We found 15 trials with 1487 patients assigned to a short period of bed rest (median 6 days) and 1471 patients assigned to longer bed rest (median 13 days). Generally the studies were outdated and appeared to be of moderate to poor methodological reporting quality. There was no evidence that shorter bed rest was more harmful than longer bed rest in terms of all cause mortality (RR 0.85, 95%CI 0.68 to 1.07), cardiac mortality (RR 0.81, 95%CI 0.54 to 1.19), or reinfarction (RR 1.07, 95%CI 0.79 to 1.44).

Authors' conclusions

Bed rest ranging from 2 to 12 days appears to be as safe as longer periods of bed rest. The quality of most trials is unsatisfactory. Current bed rest recommendations are not supported by the existing evidence as the optimal duration of bed rest is unknown. The lack of adequate trials is surprising, considering the large size of several studies to compare effectiveness of drugs on people with AMI.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Bed rest for acute uncomplicated myocardial infarction

Bed rest is an inherent part of treatment for acute myocardial infarction (AMI). In clinical practice this intervention is prescribed in different ways and for different lengths of time. Current guidelines recommend at least 12 hours bed rest following AMI. However the basis for these recommendations is unclear. This review found 15 trials which were generally outdated and of moderate to poor methodological quality. Bed rest ranging from 2 to 12 days appears to be as safe as longer periods of bed rest. No evidence was found to support the current bed rest recommendations of not more than 12-24 hours. The optimal duration of bed rest after AMI remains undetermined from the available evidence.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

臥床休息治療急性非複雜性心肌梗塞

所有急性心肌梗塞的所有病人都會被指示要臥床休息,但是休息程度不一。現今美國心臟病學會/美國心臟學會的指導方針中,建議對非複雜型ST節段上升心肌梗塞的病人,需要至少十二小時的休息。然而這個建議的立論基礎仍是未明的。

目標

比較短時或長時間臥床休息對非複雜性心肌梗塞病人的效果。

搜尋策略

我們搜尋Cochrane資料庫註冊的隨機對照試驗(The Cochrane Library, Issue 3, 2009年), MEDLINE資料庫(1966年1月至2009年10月), EMBASE資料庫(1988年1月至2009年10月), PASCAL BioMed資料庫(1996年1月至2005年8月), PsycINFO 資料庫 (1966年1月至2009年10月),以及BIOSIS資料庫(1990年1月至2009年10月)。參考書目已確認過。並無語言限制。

選擇標準

搜尋非複雜性心肌梗塞病人中有關短時間或長時間臥床休息的隨機及半隨機對照試驗。

資料收集與分析

至少有兩位審查者根據已訂好的納入條件各自獨立進行研究篩選,兩位審查者各自獨立重覆提取資料。並連絡作者取得漏失的資訊。

主要結論

我們找到15個試驗有1487位病人被指定要短時間臥床休息(休息天數之中位數6天),有1471位病人被指定要長時間臥床休息(中位數13天)。整體而言這些試驗已不合時宜並似乎只有中下程度的試驗方法設計品質。 並沒有證據顯示出短時間臥床休息要比長時間臥床休息在整體死亡率(RR = 0.85, 95%CI 0.68 to 1.07)，心臟病死亡 (RR = 0.81, 95%CI 0.54 to 1.19),或是二度梗塞(RR = 1.07, 95%CI 0.79 to 1.44)這三方面上要來的危險。

作者結論

2到12天間的臥床休息顯示出與長時間臥床休息相等的安全性。多數試驗的品質是令人不滿意的。由於適宜的臥床休息時間長短仍是未知的，所以目前臥床休息的建議並無法由現存的證據來支持。相對比於有好幾個大型試驗來比較急性心肌梗塞病人中藥物的效果,在臥床休息上卻缺乏適當的試驗是出乎意料之外的。

翻譯人

本摘要由臺北榮民總醫院魏照軒翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

臥床休息治療急性非複雜性心肌梗塞:臥床休息是急性心肌梗塞治療中具存的一部份。在臨床實用上這種介入治療法被以各種不同的方式與不同的時間長短來實施。目前的指導方針中建議於急性心肌梗塞後至少十二小時的臥床休息。然而這建議的立論基礎仍是未明的。這篇回顧文章發現了15個整體而言過時且為中下等品質之實驗設計法的試驗。2天到12天間的短時間臥床休息顯示出與長時間臥床休息相等的安全性。並沒有證據被發現來支持現今不超過12到24小時的臥床休息建議。急性心肌梗塞後最佳的臥床休息時間長短依目前現有的證據仍無法決定。

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