Cardiac Rehabilitation Attendance and Outcomes in Coronary Artery Disease Patients
Cardiac Rehabilitation Attendance and Outcomes in Coronary Artery Disease Patients
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DOI：
10.1161/circulationaha.111.066738
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发表时间：
2012-08-07
期刊：
影响因子：
37.8
通讯作者：
Aggarwal, Sandeep G.
中科院分区：
文献类型：
--
作者：
Martin, Billie-Jean;Hauer, Trina;Aggarwal, Sandeep G.
背景-心脏康复（CR）是一种有效但未充分使用的治疗冠心病患者。本研究的目的是确定CR完成和死亡率和resource utilization.Methods和结果之间的关联，我们进行了一项前瞻性队列研究的5886例（20.8%女性，平均年龄60.6岁）谁经历了血管造影术，并提到CR在卡尔加里，AB，加拿大，1996年至2009年之间。关注的结局包括CR完成者与未完成者的急诊就诊率、住院率和生存率，根据临床协变量、治疗策略和冠状动脉解剖结构进行调整。还构建了CR完成者与非完成者的事件风险比。倾向模型用于匹配完成者与未完成者的基线特征，并在倾向匹配组之间比较每个结局。在接受CR的受试者中，2900例（49.3%）完成了项目，另外554例受试者开始但未完成CR。CR完成与较低的死亡风险相关，调整后的风险比为0.59（95%置信区间，0.49-0.70）。CR完成还与全因住院（校正风险比，0.77; 95%置信区间，0.71-0.84）和心脏病住院（校正风险比，0.68; 95%置信区间，0.55-0.83）的风险降低相关，但与急诊室就诊无关。倾向匹配分析表明，CR完成和降低mortality. Conclusions，在这些冠状动脉疾病患者中，CR完成与改善生存率和降低住院率相关。有必要探讨不就诊的原因，并测试干预措施，以改善转诊后的就诊情况。（循环。2012;126：677-687）。
Background-Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients with coronary artery disease. The objective of this study was to determine the association between CR completion and mortality and resource use.Methods and Results-We conducted a prospective cohort study of 5886 subjects (20.8% female; mean age, 60.6 years) who had undergone angiography and were referred for CR in Calgary, AB, Canada, between 1996 and 2009. Outcomes of interest included freedom from emergency room visits, hospitalization, and survival in CR completers versus noncompleters, adjusted for clinical covariates, treatment strategy, and coronary anatomy. Hazard ratios for events for CR completers versus noncompleters were also constructed. A propensity model was used to match completers to noncompleters on baseline characteristics, and each outcome was compared between propensity-matched groups. Of the subjects referred for CR, 2900 (49.3%) completed the program, and an additional 554 subjects started but did not complete CR. CR completion was associated with a lower risk of death, with an adjusted hazard ratio of 0.59 (95% confidence interval, 0.49-0.70). CR completion was also associated with a decreased risk of all-cause hospitalization (adjusted hazard ratio, 0.77; 95% confidence interval, 0.71-0.84) and cardiac hospitalization (adjusted hazard ratio, 0.68; 95% confidence interval, 0.55-0.83) but not with emergency room visits. Propensity-matched analysis demonstrated a persistent association between CR completion and reduced mortality.Conclusions-Among those coronary artery disease patients referred, CR completion is associated with improved survival and decreased hospitalization. There is a need to explore reasons for nonattendance and to test interventions to improve attendance after referral. (Circulation. 2012;126:677-687.)