Baberg Henning Thomas, Uzun Demet, de Zeeuw Justus, Sinclair Ruth, Bojara Waldemar, Mügge Andreas, Schubmann Rainer
Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftliche Kliniken Bergmannsheil, Klinikum der Ruhr-Universität Bochum.
Herz. 2005 Dec;30(8):754-60. doi: 10.1007/s00059-005-2645-1.
The most important goals in the rehabilitation of patients with a coronary heart disease (CHD) include the diagnosis and treatment of risk factors, health promotion, and education. The knowledge on and awareness of cardiovascular risk factors is an important precondition for a high patient compliance. Former studies on patients in cardiologic departments of hospitals showed no effect of health promotion and education on patients' knowledge on risk factors, presumably because of the setting in acute therapy. Therefore, the possible effects of health promotion and education on the knowledge of patients were studied in the setting of an inpatient rehabilitation.
Over 1 year, 426 patients, admitted to an inhospital rehabilitation, were questioned on the first and last day of their stay using a validated instrument ("Bochumer Bewertungsbogen-Kardiovaskuläre Risikofaktoren" [BBKR], Table 1). 1 year after discharge, the same questionnaire was sent to the surviving 423 patients. Of these, 267 patients (63.1%) answered. The average age was 64.3 years (standard deviation [SD] 11.3). Demographic data and clinical history are summarized in Table 2.
For most of the known risk factors of CHD, the number of patients mentioning them significantly increased during the observation period. On the day of admittance, only 59.2% mentioned diabetes mellitus as a risk factor compared to 74.6% 1 year after discharge. Especially patients with a CHD improved their knowledge on their disease (Figure 1). Education and number of rehabilitations in the past had an influence on the knowledge of interviewed patients on the day of admittance. Especially elderly patients had an increase in knowledge, indicated by a higher score in the questionnaire (Table 3). Participation in patients' self-help meetings within the observation time had no influence on the knowledge. Patients with known hypertension or hyperlipoproteinemia and overweight patients could increase knowledge on the cardiovascular risk of their disease (Figure 2).
The results of this query document the lack of knowledge on cardiovascular risk factors of patients before rehabilitation. Especially the results of patients with a diagnosed (and treated) CHD after an inpatient stay in an acute hospital in the past were surprising. The stationary rehabilitation is an appropriate measure to improve this knowledge. It can be used for secondary prevention. The raise in knowledge was evident 1 year after discharge; a long-term effect of health education during stationary rehabilitation is likely.
冠心病（CHD）患者康复的最重要目标包括危险因素的诊断与治疗、健康促进及教育。对心血管危险因素的了解和认识是患者高依从性的重要前提。以往针对医院心内科患者的研究表明，健康促进和教育对患者关于危险因素的知识没有影响，这可能是由于急性治疗环境所致。因此，在住院康复环境中研究了健康促进和教育对患者知识水平的可能影响。
在1年多的时间里，对426名入住住院康复机构的患者在住院的第一天和最后一天使用经过验证的工具（“波鸿评估量表 - 心血管危险因素”[BBKR]，表1）进行询问。出院1年后，向423名存活患者发送相同问卷。其中，267名患者（63.1%）回复。平均年龄为64.3岁（标准差[SD] 11.3）。人口统计学数据和临床病史总结于表2。
对于大多数已知的冠心病危险因素，在观察期内提及这些因素的患者数量显著增加。入院当天，只有59.2%的患者将糖尿病列为危险因素，而出院1年后这一比例为74.6%。尤其是冠心病患者对自身疾病的了解有所改善（图1）。教育程度和过去的康复次数对入院当天受访患者的知识水平有影响。特别是老年患者的知识有所增加，问卷得分更高（表3）。在观察期内参加患者自助会议对知识水平没有影响。已知患有高血压或高脂蛋白血症的患者以及超重患者能够增加对其疾病心血管风险的认识（图2）。
本次调查结果表明康复前患者对心血管危险因素缺乏了解。特别是过去曾在急性医院住院治疗后被诊断（并接受治疗）的冠心病患者的结果令人惊讶。住院康复是改善这种知识状况的适当措施。它可用于二级预防。出院1年后知识水平的提高很明显；住院康复期间健康教育的长期效果可能存在。
