Ades P A, Huang D, Weaver S O
Division of Cardiology, University of Vermont College of Medicine, Burlington.
Am Heart J. 1992 Apr;123(4 Pt 1):916-21. doi: 10.1016/0002-8703(92)90696-s.
The effect of participation in cardiac rehabilitation on medical costs was determined by measuring hospitalization charges for cardiac admissions over a 3-year period in 580 post-coronary event patients (58% after coronary bypass surgery, 42% after myocardial infarction), of whom 230 entered a cardiac rehabilitation program and 350 did not. Baseline left ventricular ejection fraction was similar in entrants and nonentrants (59.9% vs 59.5%). Over the 1 to 46-month follow-up period (mean 21 months), per capita hospitalization charges for participants in cardiac rehabilitation were $739 lower than charges for nonparticipants ($1197 +/- 3911 vs $1936 +/- 5459, p = 0.022). This was due to both a lower incidence of hospitalizations and lower charges per hospitalization. Inasmuch as groups differed with regard to age, sex, diagnostic category, and smoking status, data were adjusted for these baseline differences by means of analysis of covariance. Rehospitalization charges remained significantly higher in nonparticipants (p = 0.015). Because physician charges were not measured, the cost differential between groups is underestimated. Results of this study show an association between participation in comprehensive cardiac rehabilitation and lowered cardiac rehospitalization costs in the years after an acute coronary event.
通过测量580例冠心病事件后患者（58%为冠状动脉搭桥术后，42%为心肌梗死后）在3年期间因心脏疾病入院的住院费用，来确定参与心脏康复对医疗费用的影响。其中230例患者进入心脏康复项目，350例未进入。进入项目者和未进入者的基线左心室射血分数相似（分别为59.9%和59.5%）。在1至46个月的随访期（平均21个月）内，心脏康复参与者的人均住院费用比未参与者低739美元（分别为1197±3911美元和1936±5459美元，p = 0.022）。这是由于住院发生率较低以及每次住院费用较低。由于两组在年龄、性别、诊断类别和吸烟状况方面存在差异，因此通过协方差分析对这些基线差异的数据进行了调整。未参与者的再次住院费用仍然显著更高（p = 0.015）。由于未测量医生费用，因此两组之间的成本差异被低估了。本研究结果表明，在急性冠状动脉事件后的几年中，参与全面心脏康复与降低心脏再次住院费用之间存在关联。
