Medical Inventions that Failed the Test of Time: Prolonged Bedrest after MI

Just as there have been many history-changing medical discoveries and inventions, there have also been ideas that shone brightly for a time and then, thankfully wilted in the glaring light of the retrospectoscope.

There is an inherent logic to the tradition of advising bedrest, even prolonged bedrest, after myocardial infarction (MI). After all, if a broken leg were to rest in a cast for six weeks, and tuberculous lungs were treated with convalescence in remote sanitoria, did it not follow that the damaged heart should also be rested? By lying still and avoiding physical stress, the ischaemic and tremulous myocardium might recover to beat again.

In this model, popular until the 1960s, the post-infarct patient would lie prone for as long as six weeks, forbidden ('doctor's orders') from attending to their own bathing or even brushing their hair. If urinary retention, DVT or pulmonary embolus should spoil the party, this was the price to be paid. Moves to allow post-MI patients to be nursed sitting out of bed, promoted first in the American Journal of Nursing by Drs Mitchell, Lown and Levine in the 1950s, were seen as radical.

Today, patients who have had a coronary artery bypass graft or new aortic valve are not only out of bed within a few days, but back at home and stumbling to the local gym for rehabilitation.

What a change a few decades makes.

Dr Jon Fogarty