Cardiac rehabilitation and survival of dialysis patients after coronary bypass
Cardiac rehabilitation and survival of dialysis patients after coronary bypass
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DOI：
10.1681/asn.2005101027
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发表时间：
2006-04-01
影响因子：
13.6
通讯作者：
Herzog, Charles A.
中科院分区：
文献类型：
--
作者：
Kutner, Nancy G.;Zhang, Rebecca;Herzog, Charles A.
肾透析患者心源性死亡的风险较高，心血管疾病负担较大，心血管疾病危险因素也较多。心脏康复可以促进冠状动脉旁路移植（CABG）手术后非透析患者生存率的提高，并且由医疗保险承保，但之前没有研究调查CABG后透析患者的生存率是否可以作为心脏康复的功能而得到改善。一项前瞻性队列研究使用 Medicare 索赔（1998 年至 2002 年）的 CABG 和心脏康复以及来自美国肾脏数据系统数据库的患者信息，对 1998 年 1 月 1 日至 2002 年 12 月 31 日期间开始血液透析并接受 CABG 的 6215 名肾脏患者进行了前瞻性队列研究，死亡率随访至 2003 年 12 月 31 日。心脏康复是根据监测和康复的现行程序术语代码定义的。医疗保险索赔数据中的非监控活动。与未接受心脏康复的透析患者相比，CABG 后接受心脏康复的透析患者的全因死亡风险降低了 35%，心源性死亡风险降低了 36%，与社会人口统计学和临床风险因素（包括近期住院治疗）无关。 CABG 后只有 10% 的患者接受了心脏康复，而一般人群中估计有 23.4% 的患者接受了心脏康复，而所有年龄段的低收入患者以及 65 岁以上的女性和黑人患者接受心脏康复服务的可能性明显较低。这项观察性研究表明，心脏康复对冠状动脉搭桥术后透析患者的生存有好处。
Patients who are on renal dialysis are at high risk for cardiac death and have a large burden of cardiovascular disease and cardiovascular disease risk factors. Cardiac rehabilitation can promote improved survival of nondialysis patients after coronary artery bypass grafting (CABG) surgery and is covered by Medicare, but no previous studies have investigated whether dialysis patients' survival after CABG may be improved as a function of cardiac rehabilitation. A prospective cohort study was conducted using Medicare claims (1998 to 2002) for CABG and cardiac rehabilitation and patient information from the United States Renal Data System database for 6215 renal patients who initiated hemodialysis and underwent CABG between January 1, 1998, and December 31, 2002, with mortality follow-up to December 31, 2003. Cardiac rehabilitation was defined by Current Procedural Terminology codes for monitored and nonmonitored exercise in Medicare claims data. Dialysis patients who received cardiac rehabilitation after CABG had a 35% reduced risk for all-cause mortality and a 36% reduced risk for cardiac death compared with dialysis patients who did not receive cardiac rehabilitation, independent of sociodemographic, and clinical risk factors, including recent hospitalization. Only 10% of patients received cardiac rehabilitation after CABG, compared with an estimated 23.4% of patients in the general population, and lower income patients of all ages as well as women and black patients who were aged 65+ were significantly less likely to receive cardiac rehabilitation services. This observational study suggests a survival benefit of cardiac rehabilitation for dialysis patients after CABG.