Cortés Olga, Arthur Heather M
McMaster University, Hamilton, Ontario, Canada.
Am Heart J. 2006 Feb;151(2):249-56. doi: 10.1016/j.ahj.2005.03.034.
Despite the documented efficacy of cardiac rehabilitation (CR), a minority of patients with diagnosed coronary artery disease are referred. Although referral is a necessary step in the promotion of CR uptake, little is known about its determinants.
The objective of this paper was to systematically review the available literature on factors predicting referral of patients to CR to appraise both their relative impact and consistency across studies.
Studies were identified by searching MEDLINE (1966-2003), CINAHL (1982-2003), HealthSTAR (1975-2003), EMBASE (1966-2003), and The Cochrane Library Controlled Trials. Search terms were "myocardial infarction," "acute myocardial infarction," "coronary artery disease," combined with "rehabilitation," "cardiac rehabilitation," "secondary prevention," "exercise training," "referral," and/or "consultation." Forty-five studies were identified and independently assessed by 2 reviewers using predetermined eligibility criteria.
Ten published observational studies (1999-2004) including 30,333 coronary artery disease patients were selected. Determinants of referral to CR were grouped as sociodemographic, health status, and health care system factors. Major predictors were English speaking (RR 9.56, 95% CI 2.18-41.93), prior myocardial infarction (RR 2.73, 95% CI 1.69-4.42), being admitted to hospitals providing CR (RR 5.35, 95% CI 4.04-7.10), and having insurance coverage (RR 2.94, 95% CI 1.13-7.66).
This review highlights disparities in referral to CR and reveals a treatment gap in the secondary prevention of cardiovascular disease. Precise estimates of the impact of all factors on referral are not possible, but some hierarchies and potential priorities for action are evident.
尽管有文献记载心脏康复（CR）具有疗效，但确诊为冠状动脉疾病的患者中只有少数人被转诊接受该治疗。虽然转诊是促进CR治疗采用率的必要步骤，但对其决定因素知之甚少。
本文的目的是系统回顾关于预测患者转诊接受CR治疗的因素的现有文献，以评估这些因素在各项研究中的相对影响和一致性。
通过检索MEDLINE（1966 - 2003年）、CINAHL（1982 - 2003年）、HealthSTAR（1975 - 2003年）、EMBASE（1966 - 2003年）以及Cochrane图书馆对照试验来确定研究。检索词为“心肌梗死”“急性心肌梗死”“冠状动脉疾病”，并与“康复”“心脏康复”“二级预防”“运动训练”“转诊”和/或“会诊”相结合。共确定了45项研究，并由2名评审员根据预先确定的纳入标准进行独立评估。
选取了10项已发表的观察性研究（1999 - 2004年），共纳入30333例冠状动脉疾病患者。转诊接受CR治疗的决定因素分为社会人口统计学因素、健康状况因素和医疗保健系统因素。主要预测因素包括说英语（相对危险度9.56，95%可信区间2.18 - 41.93）、既往心肌梗死（相对危险度2.73，95%可信区间1.69 - 4.42）、入住提供CR治疗的医院（相对危险度5.35，95%可信区间4.04 - 7.10）以及拥有保险（相对危险度2.94，95%可信区间1.13 - 7.66）。
本综述突出了CR转诊方面的差异，并揭示了心血管疾病二级预防中的治疗差距。虽然无法精确估计所有因素对转诊的影响，但一些层次结构和潜在的行动重点是明显的。
