Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis.
Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis.
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DOI：
10.1136/bmj.b5631
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发表时间：
2010-01-19
期刊：
影响因子：
--
通讯作者：
Taylor RS
中科院分区：
文献类型：
--
作者：
Dalal HM;Zawada A;Jolly K;Moxham T;Taylor RS
目的比较以家庭为基础的和以监督中心为基础的心脏康复对冠心病患者死亡率和发病率、健康相关生活质量和可改变的心脏危险因素的影响。设计系统综述。数据来源：科克伦图书馆的科克伦对照试验中心注册库（CENTRAL）、Medline、Embase、CINAHL和PsycINFO，无语言限制，检索时间为2001年至2008年1月。审查方法检查参考文献清单并征求作者的意见。纳入了在急性心肌梗死、心绞痛或心力衰竭或接受过冠状动脉血运重建的成人中比较基于中心的心脏康复与基于家庭的计划的随机对照试验。两名评审员独立评估了所确定试验的合格性，并独立提取数据。尽可能联系作者以获取缺失信息。结果共纳入12篇文献（1938例受试者）。大多数研究招募了心肌梗死或血运重建后进一步事件风险较低的患者。在死亡率方面，家庭和中心心脏康复治疗之间没有差异（相对风险1.31，95%置信区间0.65 - 2.66），心脏事件，运动能力（标准化平均差-0.11，-0.35至0.13），可改变的风险因素（加权平均收缩压差（0.58 mm Hg，−3.29 mm Hg至4.44 mm Hg），总胆固醇（−0.13 mmol/l，−0.31 mmol/l至0.05 mmol/l），低密度脂蛋白胆固醇（−0.15 mmol/l，−0.31 mmol/l至0.01 mmol/l），或随访时吸烟者比例的相对风险（0.98，0.73至1.31）），或健康相关的生活质量，除了高密度脂蛋白胆固醇（−0.06，−0.11至−0.02）mmol/l）。在以家庭为基础的参与者中，有证据表明上级依从性。两种形式的心脏康复的医疗费用没有一致的差异。结论：对于心肌梗死或血运重建后进一步事件风险较低的患者，家庭和中心形式的心脏康复似乎在改善临床和健康相关生活质量结局方面同样有效。这一发现，加上没有证据表明两种方法之间患者的依从性和医疗费用存在差异，支持进一步提供基于证据的家庭心脏康复计划，如“心脏手册”。选择参与更传统的基于监督中心或基于证据的家庭计划应反映个体患者的偏好。
Objective To compare the effect of home based and supervised centre based cardiac rehabilitation on mortality and morbidity, health related quality of life, and modifiable cardiac risk factors in patients with coronary heart disease. Design Systematic review. Data sources Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, Embase, CINAHL, and PsycINFO, without language restriction, searched from 2001 to January 2008. Review methods Reference lists checked and advice sought from authors. Included randomised controlled trials that compared centre based cardiac rehabilitation with home based programmes in adults with acute myocardial infarction, angina, or heart failure or who had undergone coronary revascularisation. Two reviewers independently assessed the eligibility of the identified trials and extracted data independently. Authors were contacted when possible to obtain missing information. Results 12 studies (1938 participants) were included. Most studies recruited patients with a low risk of further events after myocardial infarction or revascularisation. No difference was seen between home based and centre based cardiac rehabilitation in terms of mortality (relative risk 1.31, 95% confidence interval 0.65 to 2.66), cardiac events, exercise capacity (standardised mean difference −0.11, −0.35 to 0.13), modifiable risk factors (weighted mean difference systolic blood pressure (0.58 mm Hg, −3.29 mm Hg to 4.44 mm Hg), total cholesterol (−0.13 mmol/l, −0.31 mmol/l to 0.05 mmol/l), low density lipoprotein cholesterol (−0.15 mmol/l, −0.31 mmol/l to 0.01 mmol/l), or relative risk for proportion of smokers at follow-up (0.98, 0.73 to 1.31)), or health related quality of life, with the exception of high density lipoprotein cholesterol (−0.06, −0.11 to −0.02) mmol/l). In the home based participants, there was evidence of superior adherence. No consistent difference was seen in the healthcare costs of the two forms of cardiac rehabilitation. Conclusions Home and centre based forms of cardiac rehabilitation seem to be equally effective in improving clinical and health related quality of life outcomes in patients with a low risk of further events after myocardial infarction or revascularisation. This finding, together with the absence of evidence of differences in patients’ adherence and healthcare costs between the two approaches, supports the further provision of evidence based, home based cardiac rehabilitation programmes such as the “Heart Manual.” The choice of participating in a more traditional supervised centre based or evidence based home based programme should reflect the preference of the individual patient.
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DOI：
10.1097/00005768-200210000-00003
发表时间：
2002-10-01
期刊：
MEDICINE AND SCIENCE IN SPORTS AND EXERCISE
影响因子：
--
作者：
Arthur, HM;Smith, KM;McKelvie, R
通讯作者：
McKelvie, R
影响因子：
2.8
作者：
Carlson, JJ;Johnson, JA;VanderLaan, RL
通讯作者：
VanderLaan, RL
DOI：
10.1097/00008483-200501000-00006
发表时间：
2005-01-01
期刊：
Journal of cardiopulmonary rehabilitation
影响因子：
--
作者：
Grace, Sherry L;McDonald, Jennifer;Caruso, Veola
通讯作者：
Caruso, Veola
影响因子：
3.5
作者：
Dalal, H. M.;Evans, P. H.;Pereira Gray, D. J.
通讯作者：
Pereira Gray, D. J.
影响因子：
2.8
作者：
CANNISTRA, LB;BALADY, GJ;RYAN, TJ
通讯作者：
RYAN, TJ