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Abstract

Objective
To determine the impact of early mobilisation (EM) on total mortality and non-fatal re-infarction after acute myocardial infarction (AMI).

Design
Systematic review and meta-analysis.

Data sources
MEDLINE, CINAHL, HealthStar, EMBASE, the Cochrane Library Controlled Trials Registry and experts.

Methods
Target studies included published and unpublished experimental, controlled studies in any language comparing AMI patients allocated to any in-hospital early mobilisation or a control/standard treatment. Two reviewers independently assessed study eligibility and quality and performed data extraction. We calculated relative risks (RRs) and 95% confidence intervals (CIs) using the random-effects model.

Outcomes
All-cause mortality or re-infarction up to 1-year post-AMI.

Results
Out of 385 potentially relevant studies, 14 met our eligibility criteria (13 published before 1983). There were 149 deaths (9.3% of 1607) and 82 non-fatal re-infarctions (5.2% of 1580) among post-AMI patients receiving EM, compared with 179 deaths (11.6% of 1541) and 80 non-fatal re-infarctions (5.3% of 1518) among AMI patients receiving control treatment (RR=0.85, 95% CI 0.68, 1.05 and RR=1.02, 95% CI 0.75, 1.39 respectively).

Conclusion
Our meta-analysis demonstrated a trend towards decreased mortality with EM after AMI. However, there is uncertainty about early mobilisation and more research should be developed having into account all kind of differences among patients receiving treatment after AMI worldwide.

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welcome Cortes et al.’s (2009) review which was both helpful and extremely informative. The finding that early mobilisation following a myocardial infarction (MI) may reduce mortality by up to 15% is an important evidence that reinforces what ‘expert opinion’ had been suggesting to us for many years. The benefits of early ambulation are multiple and are well reviewed in this article and I will not repeat the author's findings. I do have one comment; I was surprised to see no acknowledgement or discussion of the involvement of my profession, Physiotherapy, in the safe ambulation of patients following such an event. I am surprised about this for several reasons, but mainly because following an MI the patient may be a high falls risk in addition to probably being fearful of doing so. Falling is a leading cause of mortality and morbidity and if a fall occurs in a vulnerable patient, such as one who is post-MI, it would complicate their rehabilitation substantially. It may be tempting for clinical nurses to apply Cortes et al.’s (2009) findings and start early ambulation of patients following MI. If a patient appear anxious about falling, however, or they appear to be having difficulty walking, I would advise my nursing colleagues to work with physiotherapists when considering early mobilisation to negate this falls risk. Physiotherapists are experts in this capacity; they may advice nursing colleagues on appropriate strategies to safely mobilise patients, and may also consider the value a issuing a walking aid. Failure to engage the ward physiotherapist may have tragic consequences, should a patient fall due to lack of physiotherapy guidance of the clinical team on appropriate aids and specialist advice. I welcome nurses to take a proactive approach in early patient mobilisation but urge them to consult physiotherapists for guidance on this when patients appear anxious and/or appear to be having difficulty "getting going"!.