Cardiac Rehabilitation Participation and Mortality After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
Cardiac Rehabilitation Participation and Mortality After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
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DOI：
10.1161/jaha.118.010010
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发表时间：
2018-10-02
影响因子：
5.4
通讯作者：
Whooley MA
中科院分区：
文献类型：
--
作者：
Beatty AL;Doll JA;Schopfer DW;Maynard C;Plomondon ME;Shen H;Whooley MA
经皮冠状动脉介入治疗（PCI）后，心脏康复（CR）被强烈推荐，但未得到充分利用。我们试图评估PCI术后CR参与率的变化及其与退伍军人死亡率的相关性。在退伍军人事务部临床评估、报告和跟踪数据库中确定了2007年至2011年期间接受PCI的患者，并随访至2017年1月25日。我们排除了PCI后30天内死亡的患者，并计算了PCI后12个月内参与≥1次门诊CR访视的百分比。我们构建了CR参与的多变量分层逻辑回归模型，按设施进行聚类。我们估计CR参与的倾向评分，通过倾向评分匹配参与者和非参与者，计算死亡率，并使用考克斯比例风险模型估计与死亡率的相关性。PCI术后CR的参与率为6.9%（2986/43319），PCI设施差异显著（范围，0%-36%）。经过6.1年的中位随访，CR参与者的死亡率比所有非参与者低33%（3.8 vs 5.7例死亡/100人年;风险比，0.67; 95%置信区间，0.61-0.75; P<0.001），死亡率比2986名倾向匹配的非参与者低26%（3.8 vs 5.1例死亡/100人年;风险比，0.74; 95%置信区间，0.65-0.84; P<0.001）。参加≥36次会议的参与者死亡率最低（2.4例死亡/100人年;风险比，0.47; 95%置信区间，0.36-0.60; P<0.001）。退伍军人PCI后的CR参与率总体较低，具有显著的设施水平差异。参与CR与退伍军人的低死亡率相关。需要做出更多努力，以促进退伍军人在PCI后的CR参与。
Cardiac rehabilitation (CR) is strongly recommended after percutaneous coronary intervention (PCI), but it is underused. We sought to evaluate CR participation variation after PCI and its association with mortality among veterans. Patients undergoing PCI between 2007 and 2011 were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking database and followed up until January 25, 2017. We excluded patients who died within 30 days of PCI and calculated the percentage participating in ≥1 outpatient CR visits within 12 months after PCI. We constructed multivariable hierarchical logistic regression models for CR participation, clustered by facility. We estimated propensity scores for CR participation, matched participants and nonparticipants by propensity score, calculated mortality rates, and estimated the association with mortality using Cox proportional hazards models. Participation in CR after PCI was 6.9% (2986/43 319) and varied significantly by PCI facility (range, 0%–36%). After 6.1 years median follow‐up, CR participants had a 33% lower mortality rate than all nonparticipants (3.8 versus 5.7 deaths/100 person‐years; hazard ratio, 0.67; 95% confidence interval, 0.61–0.75; P<0.001) and a 26% lower mortality rate than 2986 propensity‐matched nonparticipants (3.8 versus 5.1 deaths/100 person‐years; hazard ratio, 0.74; 95% confidence interval, 0.65–0.84; P<0.001). Participants attending ≥36 sessions had the lowest mortality rate (2.4 deaths/100 person‐years; hazard ratio, 0.47; 95% confidence interval, 0.36–0.60; P<0.001). CR participation after PCI among veterans is low overall, with significant facility‐level variation. CR participation is associated with lower mortality rates in veterans. Additional efforts are needed to promote CR participation after PCI among veterans.