Brown Todd M, Hernandez Adrian F, Bittner Vera, Cannon Christopher P, Ellrodt Gray, Liang Li, Peterson Eric D, Piña Ileana L, Safford Monika M, Fonarow Gregg C
University of Alabama at Birmingham, Birmingham, AL 35294, USA.
J Am Coll Cardiol. 2009 Aug 4;54(6):515-21. doi: 10.1016/j.jacc.2009.02.080.
Our purpose was to determine factors independently associated with cardiac rehabilitation referral, which are currently not well described at a national level.
Substantial numbers of eligible patients are not referred to cardiac rehabilitation at hospital discharge despite proven reductions in mortality and national guideline recommendations.
We used data from the American Heart Association's Get With The Guidelines program, analyzing 72,817 patients discharged alive after a myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery between January 2000 and September 2007 from 156 hospitals. We identified factors associated with cardiac rehabilitation referral at discharge and performed multivariable logistic regression, adjusted for clustering, to identify which factors were independently associated with cardiac rehabilitation referral.
Mean age was 64.1 +/- 13.0 years, 68% were men, 79% were white, and 30% had diabetes, 66% hypertension, and 52% dyslipidemia; mean body mass index was 29.1 +/- 6.3 kg/m(2), and mean ejection fraction 49.0 +/- 13.6%. All patients were admitted for coronary artery disease (CAD), with 71% admitted for myocardial infarction. Overall, only 40,974 (56%) were referred to cardiac rehabilitation at discharge, ranging from 53% for myocardial infarction to 58% for percutaneous coronary intervention and to 74% for coronary artery bypass graft patients. Older age, non-ST-segment elevation myocardial infarction, and the presence of most comorbidities were associated with decreased odds of cardiac rehabilitation referral.
Despite strong evidence for benefit, only 56% of eligible CAD patients discharged from these hospitals were referred to cardiac rehabilitation. Increased physician awareness about the benefits of cardiac rehabilitation and initiatives to overcome barriers to referral are critical to improve the quality of care of patients with CAD.
我们的目的是确定与心脏康复转诊独立相关的因素，目前在国家层面上对这些因素的描述尚不充分。
尽管有证据表明心脏康复可降低死亡率且有国家指南推荐，但大量符合条件的患者在出院时未被转诊至心脏康复。
我们使用了美国心脏协会“遵循指南”项目的数据，分析了2000年1月至2007年9月期间156家医院中因心肌梗死、经皮冠状动脉介入治疗或冠状动脉旁路移植手术而存活出院的72817例患者。我们确定了出院时与心脏康复转诊相关的因素，并进行多变量逻辑回归分析，对聚类进行校正，以确定哪些因素与心脏康复转诊独立相关。
平均年龄为64.1±13.0岁，68%为男性，79%为白人，30%患有糖尿病，66%患有高血压，52%患有血脂异常；平均体重指数为29.1±6.3kg/m²，平均射血分数为49.0±13.6%。所有患者均因冠状动脉疾病（CAD）入院，其中71%因心肌梗死入院。总体而言，只有40974例（56%）患者在出院时被转诊至心脏康复，心肌梗死患者的转诊率为53%，经皮冠状动脉介入治疗患者为58%，冠状动脉旁路移植患者为74%。年龄较大、非ST段抬高型心肌梗死以及大多数合并症的存在与心脏康复转诊几率降低相关。
尽管有充分证据表明心脏康复有益，但这些医院中只有56%符合条件的CAD出院患者被转诊至心脏康复。提高医生对心脏康复益处的认识以及采取措施克服转诊障碍对于改善CAD患者的护理质量至关重要。
