Design matters in secondary prevention: individualization and supervised exercise improves the effectiveness of cardiac rehabilitation
Design matters in secondary prevention: individualization and supervised exercise improves the effectiveness of cardiac rehabilitation
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DOI：
10.1177/1741826710397107
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发表时间：
2011-10-01
影响因子：
--
通讯作者：
MacIntyre, Paul D.
中科院分区：
文献类型：
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作者：
Clark, Alexander M.;Catto, Sonnda;MacIntyre, Paul D.
背景：医院或中心心脏康复（CR）可以延长和改善生命。然而，大多数现有的试验并没有检查设计特征的影响。为了检查这些特征的影响，本研究将个体化心脏康复方案与标准化方案进行了比较，并检查了哪些因素对方案效果贡献最大。设计：前瞻性队列分析比较了苏格兰西部城乡混合地区使用个性化中心心脏康复方案（ICR）和三年前在同一地点提供的标准化心脏康复方案（SCR）的患者。研究了方案之间和方案内部在结果方面的差异。结果：转诊到ICR的患者比转诊到SCR的患者多（749例对414例，p = 0.002），尽管转诊到ICR的总体比率较低（70%对62%，p = 0.002），但随后转诊到ICR的患者比例高出约30% （p < 0.0001）。与SCR相比，ICR与住院率降低相关（HR: 0.664； 95%可信区间（CI） 0.554 ~ 0.797）。ICR患者的住院时间也显著缩短（平均：8.02天对5.84天，p < 0.05）。参加至少75%锻炼的ICR患者住院的可能性明显低于部分参加锻炼的患者（HR 2.39, 95% CI: 1.659至3.488）或不参加锻炼的患者（HR 2.16, 95% CI: 1.482至3.143）。结论：个性化的内容和有监督的运动成分是改善临床代表性人群中基于中心的CR结果的关键设计特征。
Background: Hospital or centre-based cardiac rehabilitation (CR) can lengthen and improve life. However, most existing trials do not examine the effects of design characteristics. To examine the effects of these characteristics, this study compared an individualized cardiac rehabilitation programme to a standardized programme and examined what factors contributed most to programme effects.Design: A prospective cohort analysis was done comparing patients using an individualized centre-based cardiac rehabilitation programme (ICR) in a mixed urban-rural region of the west of Scotland, to a standardized cardiac rehabilitation programme (SCR) provided at the same site three years previously. Both inter-and intra-programme differences in outcomes were explored.Results: More patients were referred to ICR than SCR (749 versus 414 patients, p = 0.002) and the proportion of patients who subsequently attended was around 30% higher (p < 0.0001) although the overall rate of referral to ICR was lower (70% versus 62%, p = 0.002). ICR was associated with a reduction in hospital admission compared to SCR (HR: 0.664: 95% confidence interval (CI) 0.554 to 0.797). ICR patients also had significantly shorter hospitalizations (mean: 8.02 days versus 5.84 days, p < 0.05). ICR patients who attended at least 75% of the exercise sessions were significantly less likely to be hospitalized than individuals who partially attended (HR 2.39, 95% CI: 1.659 to 3.488) or did not participate in exercise sessions (HR 2.16, 95% CI: 1.482 to 3.143).Conclusions: Individualized content and supervised exercise components are key design characteristics for improving outcomes from centre-based CR in clinically representative populations.