Drory Yaacov, Gerber Yariv
Department of Rehabilitation, School of PubLic Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Harefuah. 2009 Oct;148(10):688-93, 734.
Preliminary findings of the previousLy described followup study of myocardial infarction (MI) are summarized herein. All-cause mortality was 28%. One or more cardiac events occurred in 83% of the patients: recurrent MI in 31%; unstable angina pectoris in 52%; heart failure in 23%. Coronary artery bypass surgery was performed in 35% and coronary angioplasty in 38% of the patients. Recurrence of angina/MI was observed in 55% of patients treated with bypass surgery and in 75% of those treated with angioplasty. Stroke occurred in 14% of the cohort. At the fifth interview, anginal symptoms were reported by one third of survivors and left ventricular dysfunction was found in almost half of the patients. Self-reported compliance with diet and exercise was 36% and 44%, respectively. Adequate control of blood cholesterol was 25%, of hypertension - 57%; and of diabetes - 51%. Smoking rate among smokers at the index MI was 42%. Participation in cardiac rehabiLitation at any time since the index infarction was less than 20%. Resumption of work and sexual activity among previously active participants was 83% and 87%, respectively. At the fifth interview, 44% of survivors were employed and 65% were sexually active. Health-related quality of life was inferior in female participants compared with male participants and a normative sample of women. Outcomes of all categories were predicted by sociodemographic, clinical, and psychosocial variables.
In a long-term follow-up of post-MI patients, cardiac events occurred in most participants, risk factors were not adequately controlled and participation in cardiac rehabilitation was poor. Psychosocial and socioeconomic measures had an impact on all outcomes.
(A) Further development of cardiac rehabilitation and secondary prevention services in Israel is essential; (B) psychosocial evaluation of cardiac patients should be incorporated into their routine assessment and the findings should be applied to preventive and rehabilitative care; (C) preventive services for low socioeconomic individuals should receive a high priority.
本文总结了先前描述的心肌梗死（MI）随访研究的初步结果。全因死亡率为28%。83%的患者发生了一次或多次心脏事件：31%为复发性心肌梗死；52%为不稳定型心绞痛；23%为心力衰竭。35%的患者接受了冠状动脉搭桥手术，38%的患者接受了冠状动脉成形术。接受搭桥手术的患者中55%出现心绞痛/心肌梗死复发，接受成形术的患者中75%出现复发。该队列中14%的患者发生了中风。在第五次随访时，三分之一的幸存者报告有心绞痛症状，近一半的患者存在左心室功能障碍。自我报告的饮食和运动依从性分别为36%和44%。血液胆固醇得到充分控制的比例为25%，高血压为57%，糖尿病为51%。首次发生心肌梗死时吸烟者的吸烟率为42%。自首次梗死以来任何时间参与心脏康复的比例不到20%。先前活跃的参与者恢复工作和性活动的比例分别为83%和87%。在第五次随访时，44%的幸存者有工作，65%有性活动。与男性参与者和女性规范样本相比，女性参与者的健康相关生活质量较差。所有类别结果均由社会人口统计学、临床和心理社会变量预测。
在心肌梗死后患者的长期随访中，大多数参与者发生了心脏事件，危险因素未得到充分控制，参与心脏康复的情况较差。心理社会和社会经济措施对所有结果都有影响。
（A）在以色列进一步发展心脏康复和二级预防服务至关重要；（B）应对心脏病患者进行心理社会评估，并将结果应用于预防和康复护理；（C）应高度重视为社会经济地位较低个体提供的预防服务。
