Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial.
Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial.
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DOI：
10.1161/circulationaha.115.018926
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发表时间：
2016-04-05
期刊：
影响因子：
37.8
通讯作者：
Hinderliter A
中科院分区：
文献类型：
--
作者：
Blumenthal JA;Sherwood A;Smith PJ;Watkins L;Mabe S;Kraus WE;Ingle K;Miller P;Hinderliter A
心脏康复（CR）是冠心病（CHD）患者的标准治疗。尽管有大量流行病学证据表明高压力与更差的健康结果有关，但压力管理训练（SMT）并没有常规地作为CR的一个组成部分。将151例年龄在36 ~ 84岁的冠心病门诊患者随机分为12周的综合CR组或综合CR + SMT组（CR+SMT），在治疗前后进行应激和CHD生物标志物评估。未接受CR的符合CR条件的患者的匹配样本组成了无CR对照组。所有参与者的临床事件随访时间长达5.3年（中位数= 3.2年）。随机分配至CR+SMT组的患者与随机分配至单独CR组的患者相比，复合压力水平降低幅度更大（P = 0.022），该效应主要由焦虑、痛苦和感知压力的改善驱动。两个CR组均实现了CHD生物标志物的显著且相当的改善。CR+SMT组的受试者临床事件发生率低于单纯CR组（18% vs. 33%，HR = 0.49 [0.25，0.95]，P = 0.035），两个CR组的事件发生率均低于非CR组（47%，HR = 0.44 [0.27，0.71]，P <0.001）。与标准CR相比，SMT增强的CR显著降低了压力，并改善了医疗结局。我们的研究结果表明，SMT可能会提供增量效益时，结合全面的CR，并建议SMT应纳入常规CR。www.Clinicaltrials.gov.标识符：NCT 00981253。
Cardiac rehabilitation (CR) is the standard of care for patients with coronary heart disease (CHD). Despite considerable epidemiologic evidence that high stress is associated with worse health outcomes, stress management training (SMT) is not included routinely as a component of CR. 151 outpatients with CHD aged 36 to 84 years were randomized to 12-weeks of comprehensive CR or comprehensive CR combined with SMT (CR+SMT), with assessments of stress and CHD biomarkers obtained before and after treatment. A matched sample of CR-eligible patients who did not receive CR comprised a No-CR comparison group. All participants were followed for up to 5.3 years (median = 3.2 years) for clinical events. Patients randomized to CR+SMT exhibited greater reductions in composite stress levels compared with those randomized to CR alone (P = 0.022), an effect that was driven primarily by improvements in anxiety, distress, and perceived stress. Both CR groups achieved significant, and comparable, improvements in CHD biomarkers. Participants in the CR+SMT group exhibited lower rates of clinical events compared with CR alone (18% vs. 33%, HR = 0.49 [0.25, 0.95], P = 0.035) and both CR groups had lower event rates compared to the No-CR group (47%, HR = 0.44 [0.27, 0.71], P < .001). CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with standard CR. Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR. www.Clinicaltrials.gov. Identifier: NCT00981253.