The Association of Patient Educational Attainment With Cardiac Rehabilitation Adherence and Health Outcomes.
The Association of Patient Educational Attainment With Cardiac Rehabilitation Adherence and Health Outcomes.
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DOI：
10.1097/hcr.0000000000000646
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发表时间：
2022-07-01
影响因子：
3.8
通讯作者：
中科院分区：
文献类型：
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心脏事件后参与心脏康复 (CR) 可带来许多临床益处。社会经济地位 (SES) 较低的患者接受 CR 的可能性较小。目前尚不清楚他们是否能获得与 SES 较高的患者相似的临床获益。本研究探讨了教育程度（社会经济地位的一项衡量标准）如何预测 CR 的坚持和改进。这是一项前瞻性观察性研究，纳入了 2016 年 1 月至 2019 年 12 月期间参加位于佛蒙特州伯灵顿的 CR 项目的 1407 名患者。在进入 CR 时和退出 CR 时，获取了受教育年限、吸烟状况（自我报告和客观测量）、抑郁症状水平（患者健康问卷）、自我报告的身体机能（医疗结果调查）、健康水平（峰值代谢当量、峰值摄氧量、握力）和身体成分（体重指数、腰围）。适当使用 Kruskal-Wallis 或 Pearson 卡方检验来检查教育程度与基线特征的关联。适当时使用协方差分析或逻辑回归分析来检查教育程度与 CR 期间改善的关联。教育程度与入院时检查的大多数患者特征显着相关，并且是完成 CR 疗程数量的重要预测因素。即使在控制其他变量的情况下，受教育程度较低与心肺健康改善较少相关。社会经济地位较低的患者比社会经济地位较高的患者参加 CR 的次数更少，并且可能无法从参加中获得相同水平的益处。计划需要增加该人群的出勤率，并考虑修改计划以进一步支持 CR 期间的行为改变。即使在控制其他变量的情况下，受教育程度（社会经济地位的一种衡量标准）较低的患者，心脏危险因素的发生率较高，完成的心脏康复疗程较少，健身指标的改善也较少。计划必须提高与这些高风险患者的接触。
Participating in cardiac rehabilitation (CR) after a cardiac event provides many clinical benefits. Patients of lower socioeconomic status (SES) are less likely to attend CR. It is unclear whether they attain similar clinical benefits as patients with higher SES. This study examines how educational attainment (one measure of SES) predicts both adherence to, and improvements during, CR. This was a prospective observational study of 1407 patients enrolled between January 2016 and December 2019 in a CR program located in Burlington, VT. Years of education, smoking status (self-reported and objectively measured), depression symptom level (Patient Health Questionnaire), self-reported physical function (Medical Outcomes Survey), level of fitness (peak Metabolic Equivalent, peak oxygen uptake, handgrip strength), and body composition (body mass index, waist circumference), were obtained at entry to, and for a subset (N=917), at exit from CR. Associations of educational attainment with baseline characteristics was examined using Kruskal-Wallis or Pearson’s chi-squared tests as appropriate. Associations of educational attainment with improvements during CR were examined using analysis of covariance or logistic regression as appropriate. Educational attainment was significantly associated with most patient characteristics examined at intake and was a significant predictor of the number of CR sessions completed. Lower educational attainment was associated with less improvement in cardiorespiratory fitness, even when controlling for other variables. Patients with lower-SES attend fewer sessions of CR than their higher-SES counterparts and may not attain the same level of benefit from attending. Programs need to increase attendance within this population and consider program modifications that further support behavioral changes during CR. Patients with lower levels of educational attainment (one measure of socioeconomic status), have higher rates of cardiac risk factors, complete fewer sessions of cardiac rehabilitation, and improve less on fitness measures, even when controlling for other variables. Programs must improve engagement with these high-risk patients.