Effectiveness of cardiac rehabilitation among older patients after acute myocardial infarction
Effectiveness of cardiac rehabilitation among older patients after acute myocardial infarction
复制标题
DOI：
10.1016/j.ahj.2015.08.001
复制
发表时间：
2015-11-01
影响因子：
4.8
通讯作者：
Wang, Tracy Y.
中科院分区：
文献类型：
--
作者：
Doll, Jacob A.;Hellkamp, Anne;Wang, Tracy Y.
背景指南建议急性心肌梗死后进行心脏康复，但对心脏康复对当代老年人药物依从性和临床结局的影响知之甚少。心脏康复治疗的最佳次数尚不清楚。方法我们将65岁或以上的患者纳入急性冠状动脉介入治疗结局网络注册-遵循指南（ACTION Registry-GWTG）对2007年1月至2010年12月的Medicare纵向理赔数据进行1年随访。862例患者参加了急性心肌梗死后的心脏康复治疗，平均参加次数为26次。与接受1 - 25次治疗的患者相比，接受≥ 26次治疗的患者更可能是男性，合并症和既往血运重建的患病率更低，更可能出现ST段抬高型心肌梗死。在医疗保险D部分处方覆盖的患者中，心脏康复治疗次数的增加与二级预防药物（如P2 Y（12）抑制剂和β受体阻滞剂）依从性的改善相关。参与率每增加5次，死亡率就降低（调整后的风险比[HR] 0.87，95% CI 0.83-0.92）和主要不良心脏事件的总体风险较低（校正HR 0.69，95% CI 0.65-0.73）和死亡/再入院（校正HR 0.79，95%CI 0.76-0.83）。结论在老年患者人群中，参加心脏康复治疗的次数与药物依从性的改善和剂量下下游心血管风险的降低相关-反应关系。这为老年人继续使用心脏康复提供了支持，并鼓励努力最大限度地提高出勤率。
Background Guidelines recommend cardiac rehabilitation after acute myocardial infarction, yet little is known about the impact of cardiac rehabilitation on medication adherence and clinical outcomes among contemporary older adults. The optimal number of cardiac rehabilitation sessions is not clear.Methods We linked patients 65 years or older enrolled in the Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) from January 2007 to December 2010 to Medicare longitudinal claims data to obtain 1 year follow-up.Results A total of 11,862 patients participated in cardiac rehabilitation after acute myocardial infarction, attending a median number of 26 sessions. Patients attending >= 26 sessions were more likely to be male, had lesser prevalence of comorbid conditions and prior revascularization, and were more likely to present with ST-segment elevation myocardial infarction, compared with patients attending 1 to 25 sessions. Among patients with Medicare Part D prescription coverage, increasing number of cardiac rehabilitation sessions was associated with improvement in adherence to secondary prevention medications such as P2Y(12) inhibitors and beta-blockers. Each 5-session increase in participation was associated with lower mortality (adjusted hazard ratio [HR] 0.87, 95% CI 0.83-0.92) and lower overall risk of major adverse cardiac event (adjusted HR 0.69, 95% CI 0.65-0.73) and death/readmission (adjusted HR 0.79, 95% CI 0.76-0.83).Conclusions In this older patient population, number of cardiac rehabilitation sessions attended was associated with improved medication adherence and lower downstream cardiovascular risk in a dose-response relationship. This provides support for the continued use of cardiac rehabilitation for older adults and encourages efforts to maximize attendance.