Benzer Werner, Platter Marion, Oldridge Neil B, Schwann Helmut, Machreich Kurt, Kullich Werner, Mayr Karl, Philippi Axel, Gassner Alfred, Dörler Jakob, Höfer Stefan
Department of Interventional Cardiology, Academic Hospital, Austria.
Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):441-7. doi: 10.1097/HJR.0b013e32802bf7ae.
An objective of exercise-based cardiac rehabilitation is improvement in patient-reported outcomes such as health-related quality of life as well as anxiety and depressive symptoms. There are no direct comparisons of the effectiveness of inpatient and outpatient exercise-based cardiac rehabilitation programmes on patient-reported outcomes.
In this non-randomized study we collected patient-reported outcomes data with the MacNew Heart Disease health-related quality of life questionnaire and the Hospital Anxiety and Depression Scale at baseline, 1 month and again 3 months after admission to exercise-based cardiac rehabilitation in a cohort of 216 consecutive patients enrolled either in a 4-week inpatient exercise-based cardiac rehabilitation (n=62) or a 3-month outpatient exercise-based cardiac rehabilitation (n=87) and in a usual care group (n=67) to document the natural course in patient-reported outcome variables without exercise-based cardiac rehabilitation.
Although MacNew health-related quality of life scores improved more with inpatient than outpatient exercise-based cardiac rehabilitation by month 1, the improvement was still significant in both groups at month 3 and also in the usual care group when compared to baseline. The health-related quality of life scores in the inpatient group, however, decreased between month 1 and 3 whereas they continued to improve in the outpatient group. The significant reduction in both anxiety and depressive symptoms in both exercise-based cardiac rehabilitation groups by month 1 was maintained at month 3 only with outpatient exercise-based cardiac rehabilitation. No significant changes over the 3 months were observed in the usual care group.
Significant improvements of 1-month patient-reported outcomes are achieved in patients attending inpatient as well as outpatient exercise-based cardiac rehabilitation when compared with no exercise-based cardiac rehabilitation. In contrast to inpatient exercise-based cardiac rehabilitation, however, outpatient exercise-based cardiac rehabilitation leads to a further improvement of patient-reported outcomes. These results suggest that, if patients have to be admitted for inpatient exercise-based cardiac rehabilitation, this programme should be followed by an outpatient exercise-based cardiac rehabilitation to further improve and stabilize these patient-reported outcome variables.
基于运动的心脏康复的目标之一是改善患者报告的结局，如健康相关生活质量以及焦虑和抑郁症状。目前尚无关于住院和门诊基于运动的心脏康复计划对患者报告结局有效性的直接比较。
在这项非随机研究中，我们使用MacNew心脏病健康相关生活质量问卷和医院焦虑抑郁量表，在216例连续入组的患者中收集患者报告结局数据，这些患者分别参加为期4周的住院基于运动的心脏康复（n = 62）、为期3个月的门诊基于运动的心脏康复（n = 87）或常规护理组（n = 67），在基线、入院后1个月以及基于运动的心脏康复开始后3个月再次收集数据，以记录无基于运动的心脏康复情况下患者报告结局变量的自然病程。
尽管到第1个月时，住院基于运动的心脏康复组的MacNew健康相关生活质量评分比门诊基于运动的心脏康复组改善得更多，但到第3个月时，两组的改善仍然显著，与基线相比，常规护理组也是如此。然而，住院组的健康相关生活质量评分在第1个月至第3个月之间下降，而门诊组则持续改善。仅门诊基于运动的心脏康复组在第1个月时焦虑和抑郁症状均显著减轻，并在第3个月时得以维持。常规护理组在3个月内未观察到显著变化。
与无基于运动的心脏康复相比，参加住院和门诊基于运动的心脏康复的患者在1个月时患者报告结局有显著改善。然而，与住院基于运动的心脏康复不同，门诊基于运动的心脏康复可使患者报告结局进一步改善。这些结果表明，如果患者必须住院接受基于运动的心脏康复，该计划之后应进行门诊基于运动的心脏康复，以进一步改善并稳定这些患者报告结局变量。
