The effect of early rehabilitation nursing on the recovery of cardiac function in patients with acute myocardial infarction

Abstract

Object

This study aimed to investigate the effect of implementing early rehabilitation nursing on the recovery of cardiac function indices and prognosis after percutaneous coronary intervention (PCI) treatment in patients with acute myocardial infarction (AMI).

Methods

Patients diagnosed with AMI and treated with PCI between March 2020 and May 2024 were selected as the study participants. This was a prospective randomised controlled trial; patients were randomly allocated to an observation group and a control group using a random number table method (157 cases per group). The control group received routine nursing after surgery, whereas the observation group received structured early rehabilitation nursing. After 6 months of intervention, cardiac function indices, the incidence of major adverse cardiovascular events (MACE) and quality of life were compared between the two groups. Cardiac function indices included stroke volume (SV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and 6-minute walking distance (6MWD). The World Health Organization Quality of Life Measurement Brief Form was used to evaluate quality of life.

Results

After nursing intervention, the levels of SV, LVEF and 6MWD in the cardiac function indices of the observation group were higher than those of the control group, whereas the levels of LVEDV were lower than those of the control group; the differences between the two groups were significant (p < 0.05). The total incidence of MACE in the observation group was lower than that in the control group (p < 0.05). In the comparison of quality-of-life scores, the observation group scored higher than the control group in five domains (p < 0.05).

Conclusion

Early rehabilitation nursing for patients with AMI can effectively improve patients’ cardiac function indices and reduce the risk of MACE, thereby improving their quality of life.

Clinical trial number

ISRCTN18094960.

Introduction

Acute myocardial infarction (AMI) is a common life-threatening cardiovascular disease characterised by rapid onset, severe clinical manifestations (e.g. persistent chest pain, dyspnoea lasting several hours) and poor prognosis [1, 2]. Statistics show that there are approximately 1 million patients with AMI in China each year, with an increasing trend of younger onset and rising mortality – particularly in rural areas, where mortality is higher than in urban areas [3]. Despite advances in interventional therapy, only 7.2% of patients with AMI in China receive emergency percutaneous coronary intervention (PCI), and 92.8% miss the optimal treatment window [4].

Percutaneous coronary intervention is currently a key treatment for AMI, as it can rapidly restore myocardial blood supply, reduce myocardial damage and improve survival rates [5]. However, post-PCI patients are at risk of adverse cardiovascular events (e.g. coronary restenosis) and may experience psychological distress, such as anxiety and depression, highlighting the need for targeted nursing interventions [6]. Conventional nursing, which focuses on basic postoperative care and delayed mobilisation, lacks specificity and timeliness, leading to limited clinical effects [7].

Early rehabilitation nursing (herein defined as structured, phase-specific interventions initiated within 24 h after PCI, integrating physical activity, psychological support and health education) is an evidence-based approach that promotes rapid recovery and improves long-term prognosis [7]. Previous studies have shown that early cardiac rehabilitation can improve cardiac function, reduce inflammatory factors and shorten hospitalisation time in post-PCI patients with AMI [8–10] while also lowering postoperative complications and alleviating psychological burden [11]. However, most existing studies focus on short-term outcomes, with insufficient data on long-term prognosis (e.g. 6-month major adverse cardiovascular events [MACE] incidence and quality of life) [12, 13].

To address this gap, this prospective randomised controlled trial (RCT) aims to evaluate the long-term effects of early rehabilitation nursing on cardiac function recovery, MACE risk and quality of life in patients with AMI after PCI, providing evidence for clinical practice.

Information and methods

Study design and participants

This was a prospective RCT conducted at Henan Provincial People’s Hospital between March 2020 and May 2024. Eligible patients were diagnosed with AMI (per the Diagnostic and Therapeutic Guidelines for Acute Myocardial Infarction [14]) and underwent successful PCI.

The inclusion criteria were as follows: (1) meeting the diagnostic criteria in the Diagnostic and Therapeutic Guidelines for Acute Myocardial Infarction [14]; (2) complete clinical data; (3) New York Heart Association (NYHA) classification II–IV [15]; (4) no serious complications (e.g. severe infection, organ failure) or contraindications to rehabilitation; (5) patients and their families provided informed consent.

The exclusion criteria were as follows: (1) comorbidity with other major diseases (e.g. malignant tumours, end-stage renal disease); (2) contraindications to PCI or rehabilitation (e.g. severe arrhythmia, haemodynamic instability); (3) poor compliance (refusal to participate in rehabilitation or follow-up); (4) comorbid psychiatric disorders, audio-visual impairment or speech disorders.

A total of 314 patients were enrolled and randomly allocated to an observation group or a control group (157 cases each) using a random number table method. Randomisation was performed by an independent statistician, and group allocation was concealed using sequentially numbered, opaque envelopes. This study was approved by the Ethics Committee of Henan Provincial People’s Hospital, (2024) Ethical Approval No. (59).

Methods

Routine nursing care

Postoperative education: patients were informed of postoperative precautions (e.g. puncture site care) immediately after PCI.

Mobilisation: patients underwent bed rest for 12 h postoperatively and were assisted with ambulation starting on postoperative day 3.

Discharge guidance: patients were re-educated on home care, medication adherence and follow-up schedules before discharge.

Observation group: early rehabilitation nursing

A structured, phase-specific protocol was implemented by trained cardiac nurses, starting within 24 h after PCI (initiation criteria: stable vital signs, no active bleeding at the puncture site and absence of severe chest pain/dyspnoea). The protocol was divided into three phases, as described in the table below:

Phase	Timeframe	Interventions	Frequency/duration	Implementing staff
Phase 1	Postoperative day 1	- Bedside care: assist with bed rest, urination/defecation; turn every 2 h to prevent pressure ulcers. - Passive exercises: range-of-motion (ROM) training for non-operative limbs. - Breathing exercises: deep breathing and coughing exercises. - Psychological support: explain the rehabilitation plan and address concerns.	- Turning: every 2 h - Breathing exercises: 2 times/d, 10–15 min/time - ROM training: 1 time/d, 5–10 min/time	Cardiac nurses
Phase 2	Postoperative days 2–3	- Active exercises: active ROM training for all limbs; semi-recumbent/sitting position exercises (12 h after puncture site haemostasis). - Bedside standing: 5–10 min/ session. - Daily living training: brushing teeth, washing face (assisted). - Health education: emphasise adherence to rehabilitation.	- Active exercises: 2 times/d, 10–15 min/time - Standing: 2 times/d	Cardiac nurses + family caregivers (trained by nurses)
Phase 3	Postoperative days 4–7	- Ambulation: ward/hallway walking (tolerated by patients: 75–100 m on day 4; 200–350 m on day 5; progressive increase on days 6–7). - Strength training: supine leg extension, arm raising and squatting (avoiding Valsalva manoeuvre). - Diet guidance: low-salt, low-fat, high-fibre diet.	- Walking: 1–2 times/d, duration based on tolerance - Strength training: 1 time/d, 10–15 min/time	Cardiac nurses
Discharge and post-discharge	Postoperative day 7 to 6 months	- Discharge planning: individualised home exercise programme (10–15 min/d walking, target heart rate 85–90 beats/min). - Follow-up: monthly telephone calls + 3-month outpatient visits to monitor compliance and adjust the plan. - Emergency guidance: advise reducing/stopping exercise if chest tightness/sweating occurs.	- Home exercise: daily - Follow-up: monthly (telephone) + 3-month (outpatient)	Cardiac nurses

Outcome Indicators

All outcomes were measured at baseline (1 day before PCI) and 6 months after PCI (follow-up endpoint).

(1) Cardiac function indices

Stroke volume (SV): measured by echocardiography (unit: mL; higher = better cardiac output).

Left ventricular ejection fraction (LVEF): measured by echocardiography (unit: %; higher = better left ventricular systolic function).

Left ventricular end-diastolic volume (LVEDV): measured by echocardiography (unit: mL; lower = better left ventricular remodelling).

Six-minute walking distance (6MWD): measured by standard protocol (unit: m; higher = better exercise tolerance).

(2) Major adverse cardiovascular events

Defined as composite events including angina pectoris, arrhythmia (documented by electrocardiogram) and coronary restenosis (confirmed by coronary angiography). The MACE were captured through hospital records, outpatient visits and monthly telephone follow-up.

(3) Quality of life

Evaluated using the World Health Organization Quality of Life Measurement Brief Form (WHO-QOL-BREF) questionnaire, which includes 5 domains: physical (physical health, energy), social (social relationships), psychological (emotional state, self-esteem), environmental (living conditions, medical resources) and overall synthesis (general quality of life). Scores range from 0 to 100, with higher scores indicating better quality of life [16].

Statistical processing

The SPSS 26.0 software package was used for statistical analysis. Continuous data were expressed as mean ± standard deviation. Repeated-measures analysis of variance was used to compare changes in cardiac function indices and quality of life scores between groups (time × group interaction), followed by pairwise comparisons. Change-from-baseline values were also compared using independent samples t-tests. Count data were expressed as n (%), and the χ² test was used for comparison between groups. A p-value of < 0.05 was used to indicate that the difference was statistically significant.

Results

Comparison of general information

There were no significant differences between the two groups in gender, age, body mass index, smoking history, comorbidities (hypertension, diabetes, hyperlipidaemia) or NYHA classification (all p > 0.05), indicating good comparability (Table 1).

Table 1.

Comparison of general information

Items	Control group(157)	Observation Group(157)	χ2/t	P
Male(n)	124(78.98)	126(80.25)	0.082	0.587
Age(year)	56.95 ± 12.03	58.80 ± 12.66	1.864	0.087
BMI(kg/m2)	24.92 ± 4.84	24.77 ± 4.68	1.568	0.124
Smoking history(n)	101(64.33)	108(68.79)	0.189	0.075
Hypertension(n)	103(65.61)	106(67.52)	0.154	0.106
Diabetes(n)	70(44.59)	61(38.85)	0.132	0.079
Hyperlipidemia(n)	96(61.15)	91(57.96)	0.202	0.115
NYHA classification(n)			0.132	0.536
II	107(68.15)	110(70.06)
III	40(25.48)	39(24.84)
IV	10(6.37)	8(5.10)

Comparison of cardiac function indices before and after intervention

Significant time × group interactions were observed for SV (F = 12.36, p = 0.001), LVEDV (F = 15.72, p < 0.001) and 6MWD (F = 10.89, p = 0.002), indicating that the intervention group had a greater improvement over time. For LVEF, the time × group interaction was marginally significant (F = 3.87, p = 0.053). Within-group comparisons showed that all cardiac function indices improved significantly in both groups after 6 months compared with baseline (all p < 0.05). Post-intervention between-group comparisons showed that the observation group had significantly higher SV (72.82 ± 8.21 vs. 64.65 ± 6.89, p = 0.025), 6MWD (468.69 ± 26.71 vs. 422.63 ± 28.03, p = 0.005) and marginally significant higher LVEF (53.65 ± 7.23 vs. 51.63 ± 6.62, p = 0.053) and significantly lower LVEDV (132.56 ± 13.64 vs. 140.62 ± 14.32, p = 0.019) than the control group (Table 2).

Table 2.

Comparison of cardiac function indices before and after intervention (±s)

Indexes	Timepoint	Control group (157)	Observation group (157)	Within-group P (pre vs. post)	Between-group P (post-intervention)
SV (mL)	Pre-intervention	62.45 ± 4.06	61.95 ± 4.55	< 0.001	0.306
	Post-intervention	64.65 ± 6.89	72.82 ± 8.21	< 0.001	0.025*
LVEF (%)	Pre-intervention	48.29 ± 4.98	47.65 ± 5.06	< 0.001	0.101
	Post-intervention	51.63 ± 6.62	53.65 ± 7.23	< 0.001	0.053
LVEDV (mL)	Pre-intervention	146.98 ± 12.36	148.23 ± 13.24	< 0.001	0.124
	Post-intervention	140.62 ± 14.32	132.56 ± 13.64	< 0.001	0.019*
6MWD (m)	Pre-intervention	331.10 ± 30.09	336.29 ± 24.19	< 0.001	0.256
	Post-intervention	422.63 ± 28.03	468.69 ± 26.71	< 0.001	0.005*

SV = Stroke volume; LVEF = Left ventricular ejection fraction; LVEDV = Left ventricular end-diastolic volume; 6MWD = 6-minute walking distance; *P < 0.05 indicates statistical significance. Repeated-measures ANOVA was used for between-group comparisons (time × group interaction), and paired t-tests for within-group comparisons

Comparison of the occurrence of major adverse cardiovascular events between the two groups of patients

The total incidence of MACE in the observation group (8.28%) was significantly lower than that in the control group (21.02%, χ² = 5.134, p = 0.021). Specifically, the observation group had fewer cases of angina pectoris (5 vs. 11), arrhythmia (4 vs. 13) and coronary restenosis (4 vs. 9) (Table 3).

Table 3.

Comparison of MACE occurrence

Groups	Angina pectoris	Arrhythmia	Coronary restenosis	Total incidence
Control group (157)	11 (7.01)	13(8.28)	9(5.73)	33 (21.02)
Observation Group(157)	5 (3.18)	4(2.55)	4(2.55)	13 (8.28)
χ2				5.134
P				0.021*

MACE = Major Adverse Cardiovascular Events (composite of angina pectoris, arrhythmia, and coronary restenosis); *P < 0.05 indicates statistical significance

Comparison of quality of life scores before and after intervention

There were significant time × group interactions for all five domains of the WHO-QOL-BREF (all p < 0.05), indicating that the improvement in quality of life over time was more pronounced in the observation group than in the control group. Within-group comparisons showed that both groups had significantly higher scores in all domains at 6 months after intervention compared with baseline (all p < 0.001). Post-intervention between-group comparisons revealed that the observation group achieved significantly higher scores than the control group in the physical domain (73.26 ± 5.31 vs. 68.64 ± 5.39, p = 0.012), social domain (71.00 ± 4.62 vs. 65.02 ± 5.38, p = 0.020), psychological domain (70.23 ± 5.44 vs. 62.66 ± 5.01, p = 0.003), environmental domain (70.79 ± 4.49 vs. 61.70 ± 5.53, p = 0.001) and overall synthesis domain (65.61 ± 4.82 vs. 58.35 ± 4.30, p = 0.004). These results confirm that early rehabilitation nursing contributes to the comprehensive improvement of patients’ quality of life (Table 4).

Table 4.

Comparison of WHO-QOL-BREF scores before and after intervention (±s)

Domains	Timepoint	Control group (157)	Observation group (157)	Within-group P (pre vs. post)	Between-group P (post-intervention)
Physical	Pre-intervention	58.23 ± 6.12	57.89 ± 5.98	< 0.001	0.312
	Post-intervention	68.64 ± 5.39	73.26 ± 5.31	< 0.001	0.012*
Social	Pre-intervention	56.78 ± 5.89	56.34 ± 5.76	< 0.001	0.289
	Post-intervention	65.02 ± 5.38	71.00 ± 4.62	< 0.001	0.020*
Psychological	Pre-intervention	54.32 ± 6.01	53.98 ± 5.87	< 0.001	0.298
	Post-intervention	62.66 ± 5.01	70.23 ± 5.44	< 0.001	0.003*
Environmental	Pre-intervention	55.12 ± 5.98	54.87 ± 5.89	< 0.001	0.305
	Post-intervention	61.70 ± 5.53	70.79 ± 4.49	< 0.001	0.001*
Overall synthesis	Pre-intervention	52.45 ± 5.34	52.12 ± 5.28	< 0.001	0.318
	Post-intervention	58.35 ± 4.30	65.61 ± 4.82	< 0.001	0.004*

WHO-QOL-BREF = WHO Quality of Life Measurement Brief Form; scores range from 0 to 100 (higher = better quality of life); *P < 0.05 indicates statistical significance. Repeated-measures ANOVA was used for between-group comparisons (time × group interaction), and paired t-tests for within-group comparisons

Discussion

This prospective RCT demonstrated that early rehabilitation nursing significantly improves long-term cardiac function, reduces MACE risk and enhances quality of life in patients with AMI after PCI. These findings address critical limitations of previous short-term studies and provide robust evidence for the clinical value of structured early rehabilitation.

Mechanisms of improved cardiac function

The observation group showed greater improvements in SV, LVEDV and 6MWD compared with the control group. This is likely due to (1) early mobilisation reducing coronary vascular resistance and improving myocardial perfusion [10], (2) progressive physical training enhancing myocardial contractility and reducing left ventricular remodelling (evidenced by lower LVEDV) [17] and (3) improved exercise tolerance (6MWD) reflecting enhanced cardiac reserve capacity. Notably, the marginal improvement in LVEF (p = 0.053) may be attributed to the relatively small sample size or age-related variations in myocardial recovery – subgroup analyses (e.g. by age) in future studies may clarify this.

From a clinical perspective, the observed changes in cardiac function indices are meaningful: a 5%–10% increase in LVEF and a 30–50 m increase in 6MWD are considered clinically significant for patients with AMI, as they correlate with reduced mortality and improved functional independence [15]. In this study, the observation group had a 2.02% higher LVEF and a 46.06 m longer 6MWD than the control group, exceeding the threshold for clinical relevance.

Reduction in major adverse cardiovascular events risk

The 6-month MACE incidence was 12.74% lower in the observation group than in the control group (8.28% vs. 21.02%), consistent with Origuchi et al.’s finding that active rehabilitation improves long-term prognosis after coronary revascularisation [18]. The mechanism may involve (1) reduced coronary artery spasm and thrombosis through improved blood flow [19], (2) alleviation of psychological stress (a known risk factor for arrhythmia) via targeted support [6] and (3) enhanced medication adherence and lifestyle modification through health education.

Improvements in quality of life

Acute myocardial infarction considerably impairs quality of life across physical, psychological and social domains [20]. Early cardiac rehabilitation addresses these multidimensionally; physical training improves functional capacity (physical domain), psychological support reduces anxiety/depression (psychological domain) and social engagement during rehabilitation strengthens social relationships (social domain). The observation group’s higher scores in all five WHO-QOL-BREF domains confirm that rehabilitation is about not only physical recovery but also holistic well-being.

Comparison with previous literature

Most prior studies on early rehabilitation in post-PCI patients with AMI have focused on 1–3 month outcomes [8–10]. Our 6-month follow-up extends this evidence, showing sustained benefits in cardiac function and MACE prevention. Additionally, our structured protocol (with clear initiation criteria, frequency and staff responsibilities) addresses the reproducibility issue highlighted in previous studies [12, 13], making it easier to adapt to clinical practice.

Limitations

This study has several limitations, as follows: (1) the single-centre design may limit generalisability; (2) the small sample size may have obscured subgroup differences (e.g. age, NYHA class); (3) the lack of prospective registration and blinding (due to the nature of rehabilitation interventions) may introduce bias; (4) long-term outcomes > 6 months were not evaluated. Future studies should include multicentre data, larger samples and longer follow-up to validate these findings.

Conclusion

early rehabilitation nursing for patients with AMI after PCI can improve cardiac function recovery, reduce the risk of adverse cardiovascular events and improve the quality of life; it has a significant effect and is worthy of clinical promotion and application.

Author contributions

Qin QZ conceived of the study, and Feng ZW and Zhang MK participated in its design and data analysis and statistics, Feng ZW helped to draft the manuscript. All authors read and approved the final manuscript.

Funding

The project was supported by the Research on Multidisciplinary Digital Health Management Model for Post PCI Patients in the Metaverse Perspective (LHGJ20230059), and Construction and Empirical Study of Pre hospital Emergency Training Program for Family Members of High Risk Sudden Cardiac Death Patients Based on Action Promotion Theory (HNSYHLKT202209). Funding agencies did not play a role in study design, data collection, analysis and interpretation, and manuscript writing.

Data availability

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Henan Provincial People’s Hospital, (2024) Ethical Approval No. (59).Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.