"Doctor, how much damage was there to my heart?" "When can I go home?" Any physician who has worked in a coronary care unit will recognize these two questions as the most common ones asked by patients recovering from myocardial infarction. Until the 1950s, patients were told that the infarcted heart was like a fractured bone, best treated by immobilization and a hospital stay of four to six weeks. A major advance, albeit extremely controversial when introduced, was to put a chair next to the hospital bed so that the patient could assume a comfortable seated posture. The duration of hospitalization was progressively shortened after the benefits of early ambulation were recognized and after submaximal exercise testing was developed. In the United States, patients with an uncomplicated myocardial infarction are now hospitalized for approximately five days, not six weeks. However, the duration of hospitalization for myocardial infarction can vary by as much as a factor of three in different parts of the world, partly because of sociocultural preferences. Variation has been found even in systems with uniform hospital funding and medical insurance.



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