Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS)
Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management Study (CHARMS)
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DOI：
10.1016/j.ijcard.2006.11.018
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发表时间：
2007-07-10
影响因子：
3.5
通讯作者：
Pereira Gray, D. J.
中科院分区：
文献类型：
--
作者：
Dalal, H. M.;Evans, P. H.;Pereira Gray, D. J.
背景：急性心肌梗死后参与心脏康复是次优的。提供以家庭为基础的康复可能会提高吸收率。我们报告了第一个随机研究心脏康复，包括病人的喜好。目的：比较心肌梗死后家庭康复与医院康复的临床效果，并确定患者的选择是否影响临床结局。设计：患者偏好的实用随机对照试验。地点：英格兰西南部乡村。研究方法：无并发症的心肌梗死患者在护士的支持下接受8-10周的医院康复课程或6周的自助治疗（心脏手册）。9个月时的主要结局是医院焦虑抑郁量表的平均抑郁和焦虑评分、心肌梗死后生活质量（MacNew）评分和血清总胆固醇。结果：在同意参加的230例患者中，104例（45%）同意随机分组，126例（55%）选择了康复计划。84/104（81%）例随机化患者和100/126（79%）例首选患者的9个月随访数据可用。在随访中，随机家庭组和医院组的平均抑郁评分变化没有差异（平均差异：0;95%置信区间，-1.12至1.12）也不是平均焦虑评分（-0.07; -1.42至1.28），平均总体MacNew评分（0.14; -0.35至0.62）和平均总胆固醇水平（-0.18; -0.62至0.27）。偏好组之间的结果也没有任何显着差异。结论：对于心肌梗死后患者，使用心脏手册进行家庭心脏康复与医院康复一样有效。选择一个康复计划并没有显着影响临床结果。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
Background: Participation in cardiac rehabilitation after acute myocardial infarction is sub-optimal. Offering home-based rehabilitation may improve uptake. We report the first randomized study of cardiac rehabilitation to include patient preference. Aim: To compare the clinical effectiveness of a home-based rehabilitation with hospital-based rehabilitation after myocardial infarction and to determine whether patient choice affects clinical outcomes. Design: Pragmatic randomized controlled trial with patient preference arms. Setting: Rural South West England. Methods: Patients admitted with uncomplicated myocardial infarction were offered hospital-based rehabilitation classes over 8-10 weeks or a self-help package of six weeks' duration (the Heart Manual) supported by a nurse. Primary outcomes at 9 months were mean depression and anxiety scores on the Hospital Anxiety Depression scale, quality of life after myocardial infarction (MacNew) score and serum total cholesterol. Results: Of the 230 patients who agreed to participate, 104 (45%) consented to randomization and 126 (55%) chose their rehabilitation programme. Nine month follow-up data were available for 84/104 (81%) randomized and 100/126 (79%) preference patients. At follow-up no difference was seen in the change in mean depression scores between the randomized home and hospital-based groups (mean difference: 0;95% confidence interval, -1.12 to 1.12) nor mean anxiety score (- 0.07; -1.42 to 1.28), mean global MacNew score (0.14; -0.35 to 0.62) and mean total cholesterol levels (- 0.18; -0.62 to 0.27). Neither were there any significant differences in outcomes between the preference groups. Conclusions: Home-based cardiac rehabilitation with the Heart Manual was as effective as hospital-based rehabilitation for patients after myocardial infarction. Choosing a rehabilitation programme did not significantly affect clinical outcomes. (c) 2006 Elsevier Ireland Ltd. All rights reserved.