Johnson Natalie A, Inder Kerry J, Bowe Steven J
School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.
Eur J Cardiovasc Prev Rehabil. 2010 Feb;17(1):77-82. doi: 10.1097/HJR.0b013e3283304060.
Cardiac rehabilitation (CR) is an underutilized evidence-based treatment. We described trends in referral to outpatient CR (OCR) and the factors associated with referral.
Cross-sectional survey data provided by Hunter residents aged 20 years or older discharged from public hospitals in the region between 2002 and 2007 with an OCR eligible diagnosis were extracted from the Hunter New England Heart and Stroke Register database.
Trends in referral were determined using the chi test for trend. Factors associated with referral were examined using multiple logistic regression.
Sixty-five percent (4971 of 7678) of patients provided sufficient data for inclusion in the analysis. Approximately half of the patients reported being referred to OCR. No increase over time was observed. Factors associated with referral were age less than 70 years, male sex, being married, urban residence, at least one admission to the tertiary referral hospital for cardiology, at least one admission for acute myocardial infarction, revascularization, no admissions for congestive heart failure, a self-reported history of high cholesterol, and no history of stroke or atrial fibrillation.
Access to this treatment of proven benefit remained suboptimal despite the provision of new programs and expansion of existing programs. Automatic referral, which is recommended in Australia, should be standard practice.
心脏康复（CR）是一种未得到充分利用的循证治疗方法。我们描述了门诊心脏康复（OCR）转诊的趋势以及与转诊相关的因素。
从亨特新英格兰心脏与卒中登记数据库中提取2002年至2007年间该地区公立医院出院的20岁及以上符合OCR诊断标准的亨特居民提供的横断面调查数据。
使用趋势卡方检验确定转诊趋势。使用多元逻辑回归分析与转诊相关的因素。
65%（7678例中的4971例）患者提供了足够的数据纳入分析。约一半患者报告被转诊至OCR。未观察到随时间的增加。与转诊相关的因素包括年龄小于70岁、男性、已婚、城市居住、至少一次入住三级转诊医院心内科、至少一次因急性心肌梗死入院、血管重建、无充血性心力衰竭入院、自我报告的高胆固醇病史以及无中风或房颤病史。
尽管提供了新的项目并扩大了现有项目，但获得这种已证实有益的治疗仍不理想。澳大利亚推荐的自动转诊应成为标准做法。
