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Article |

Intervention After Myocardial Infarction

Robert West, MD; Dee Jones
Arch Intern Med. 1997;157(11):1268. doi:10.1001/archinte.1997.00440320178023.
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T meta-analysis of trials of psychosocial interventions following myocardial infarction, which was published by Linden et al,1 not only suggests reductions in 2-year mortality greater than those shown by aspirin, β-blocker, and thrombolysis, but also claims that these mortality reductions are over and above those to be expected in cardiac rehabilitation programs. Other investigators have reviewed the same literature and drawn rather more cautious conclusions.2,3

There are risks as well as benefits in statistical overview (or meta-analysis),4,5 particularly if the overview is not rigorous or complete,5 since, then, it is only masquerading as science. Linden and colleagues' recent pooling of trials of psychological rehabilitation suffers in a number of important respects. They include many extremely small trials and in the tally of 22 (trials) enter several twice. They omit several others, eg, those of Naismith et al,7 Mayou et al,8 and the P.RE. COR


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