Hotta S S
Health Technol Assess Rep. 1991(3):1-10.
Cardiac rehabilitation programs are safe and effective in improving the functional activities of patients with cardiac disease, but they may be hazardous to those patients whose life might be in jeopardy if subjected to exercise. It is clear that not all cardiac patients require supervised rehabilitation programs to return to normal pre-cardiac-event activities. Many patients who have suffered cardiac events recover from the events without much functional debilitation, usually because they were normally active prior to the cardiac event. Patients who have had heart transplants, percutaneous transluminal coronary angioplasty, or heart valve surgery have no unique characteristics that differentiate them from cardiac patients who have had a myocardial infarction or coronary artery bypass graft or who have stable angina in terms of the necessity for participating in supervised rehabilitation programs. Therefore, patients who have had these surgical procedures might be selected for enrollment in cardiac rehabilitation programs on the basis of their physical and psychological conditions. Those patients who benefit from rehabilitation programs usually accomplish their goals within the 12-week sessions of the usual programs. Patients with stable cardiac conditions who are at high risk and have minimal functional capacities (3-5 METs) appear to benefit most, while patients who are of low risk and have functional capacities of 7-9 METs have minimal need for the program. High-risk patients have been described as including those who develop ventricular arrhythmias or marked ischemia with exercise. Low-risk patients have been described as including those who have functional capacities at 3 weeks postoperation of 8 METs or more, which allows them to resume most of their vocational and recreational activities. Patients with intermediate risk and functional capacities benefit from the programs, but they may not require the full 12 weeks of participation. The latter group may safely exit the programs when they attain the goals of the cardiac rehabilitation programs, e.g., the resumption of pre-cardiac-event activities and return to a relatively normal life. Accordingly, heart transplant patients and patients who have undergone percutaneous transluminal coronary angioplasty or heart valve surgery could benefit from prescribed cardiac rehabilitation programs if they have the need as described. The available information implies that many heart transplant, PTCA, or heart valve surgery patients are in excellent functional status after the surgical intervention and require minimal or no supervised exercise programs. However, a significant number of patients may lack confidence in their capabilities and may benefit from earlier exercise testing that would demonstrate to them their functional capabilities.(ABSTRACT TRUNCATED AT 400 WORDS)
心脏康复计划对于改善心脏病患者的功能活动是安全有效的，但对于那些如果进行运动生命可能会受到威胁的患者来说，这些计划可能是危险的。显然，并非所有心脏病患者都需要在监督下进行康复计划才能恢复到心脏事件前的正常活动。许多经历过心脏事件的患者在事件后恢复良好，没有明显的功能衰退，通常是因为他们在心脏事件发生前通常很活跃。接受过心脏移植、经皮腔内冠状动脉成形术或心脏瓣膜手术的患者，在参与监督康复计划的必要性方面，与患有心肌梗死、冠状动脉旁路移植术或稳定型心绞痛的心脏病患者没有独特的区别。因此，接受过这些手术的患者可以根据其身体和心理状况被选择参加心脏康复计划。那些从康复计划中受益的患者通常会在常规计划的12周疗程内实现他们的目标。病情稳定但风险高且功能能力最低（3 - 5代谢当量）的患者似乎受益最大，而风险低且功能能力为7 - 9代谢当量的患者对该计划的需求最小。高风险患者被描述为包括那些运动时出现室性心律失常或明显缺血的患者。低风险患者被描述为包括那些术后3周功能能力达到8代谢当量或更高的患者，这使他们能够恢复大部分职业和娱乐活动。中度风险和功能能力的患者从这些计划中受益，但他们可能不需要完整的12周参与时间。当后者达到心脏康复计划的目标，如恢复心脏事件前的活动并回归相对正常的生活时，他们可以安全地退出计划。因此，心脏移植患者以及接受过经皮腔内冠状动脉成形术或心脏瓣膜手术的患者，如果有所述需求，可能会从规定的心脏康复计划中受益。现有信息表明，许多心脏移植、经皮腔内冠状动脉成形术或心脏瓣膜手术患者在手术干预后功能状态良好，需要极少或不需要监督运动计划。然而，相当数量的患者可能对自己的能力缺乏信心，可能会从早期运动测试中受益，这些测试可以向他们展示自己的功能能力。（摘要截取自400字）
