Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Room J1b-110, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
Neth Heart J. 2011 Jun;19(6):285-9. doi: 10.1007/s12471-011-0104-6.
In 2004, the Netherlands Society of Cardiology released the current guideline on cardiac rehabilitation. Given its complexity and the involvement of various healthcare disciplines, it was supplemented with a clinical algorithm, serving to facilitate its implementation in daily practice. Although the algorithm was shown to be effective for improving guideline adherence, several shortcomings and deficiencies were revealed. Based on these findings, the clinical algorithm has now been updated. This article describes the process and the changes that were made.
The revision consisted of three phases. First, the reliability of the measurement instruments included in the 2004 Clinical Algorithm was investigated by evaluating between-centre variations of the baseline assessment data. Second, based on the available evidence, a multidisciplinary expert advisory panel selected items needing revision and provided specific recommendations. Third, a guideline development group decided which revisions were finally included, also taking practical considerations into account.
A total of nine items were revised: three because of new scientific insights and six because of the need for more objective measurement instruments. In all revised items, subjective assessment methods were replaced by more objective assessment tools (e.g. symptom-limited exercise instead of clinical judgement). In addition, four new key items were added: screening for anxiety/depression, stress, cardiovascular risk profile and alcohol consumption.
Based on previously determined shortcomings, the Clinical Algorithm for Cardiac Rehabilitation was thoroughly revised mainly by incorporating more objective assessment methods and by adding several new key areas.
2004 年，荷兰心脏病学会发布了现行的心脏康复指南。鉴于其复杂性以及涉及多个医疗保健学科，该指南附有一个临床算法，旨在促进其在日常实践中的实施。尽管该算法已被证明可有效提高指南的依从性，但仍发现了一些缺点和不足。基于这些发现，该临床算法现已更新。本文介绍了这一过程以及所做的更改。
修订工作包括三个阶段。首先，通过评估基线评估数据的中心间差异，调查 2004 年临床算法中包含的测量仪器的可靠性。其次，根据现有证据，多学科专家咨询小组选择需要修订的项目，并提供具体建议。第三，指南制定小组决定最终包含哪些修订内容，同时也考虑到实际因素。
共修订了九项内容：其中三项是因为新的科学发现，六项是因为需要更客观的测量仪器。在所有修订的项目中，主观评估方法都被更客观的评估工具所取代（例如，症状限制运动而不是临床判断）。此外，还增加了四个新的关键项目：焦虑/抑郁、压力、心血管风险概况和酒精摄入筛查。
根据先前确定的缺点，心脏康复临床算法进行了全面修订，主要是通过纳入更多客观的评估方法，并增加了几个新的关键领域。
