Heart attacks are common, and bed rest is perhaps the commonest component of their management. But, the question of how long people should rest for remains unanswered. A new Cochrane review in Issue 2, 2007 of The Cochrane Library sought to find the answer, but found instead that the research is old and weak, and that current guidelines are probably based more on opinion than evidence.
Bed rest after a heart attack is thought to reduce strain on the heart and makes it easier to monitor the patient’s condition. On the other hand, staying in bed too long might lead to complications, as well as lowering a patient’s morale or sense of well being. It would, therefore, appear to be a prime area for randomised trials to identify an optimum duration.
People embarking on a systematic review of the topic would hope that this had been the case in the past, so that by reviewing the evidence, they could present reliable knowledge for the future. The authors of the new Cochrane review cast their net wide in the search for randomised trials to do this. They did not include language restrictions and were willing to include trials from before the time of the electronic databases such as MEDLINE. What they wanted was as many good trials as possible, comparing different durations of bed rest.
What they found was fifteen trials, with a total of nearly 3000 patients, published between the 1950s and the 1980s. The shorter duration of bed rest in these trials ranged from 2 to 14 days. While, the longer duration ranged from 5 days to four weeks. The median for the two groups was 6 and 13 days, respectively. In contrast, some current advice is that people should have just 12 to 24 hours of bed rest after a heart attack.
In general, these old trials did not favour the longer over the shorter durations. However, the quality of the trials, or at least of their reporting, was usually poor. The authors of the review conclude that it is not possible to make a definitive judgement on whether shorter or longer durations of bed rest are safer for patients. They suggest that guidance which recommends as little as 12 hours bed rest is based on opinion and the practical requirements of managing coronary care beds, rather than evidence that this is the best way to manage patients.
This Cochrane review is available in full at www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003836/frame.html
Insider
July 9 2007