Barts and the London NHS Trust, London Chest Hospital, London E2 9JX, United Kingdom.
Int J Nurs Stud. 2012 Jun;49(6):755-71. doi: 10.1016/j.ijnurstu.2011.11.019. Epub 2011 Dec 23.
The objective of this systematic review was to explore the effects of cardiac rehabilitation interventions on the quality of life of patients with coronary heart disease with a specific focus on interventions that could be delivered within the context of a publicly funded health service.
Systematic review of trials reporting quality of life data as an outcome measure. Electronic databases (CINAHL, MEDLINE and PsycINFO) were searched from 1 January 1999 to 25 November 2010 in the English language. Inclusion criteria were: randomised controlled trials of cardiac rehabilitation as configured for a publicly funded health service. Data were extracted by one reviewer and checked by a second reviewer.
The 16 papers reported RCTs conducted in nine countries. Fifteen measurement instruments were utilised to measure quality of life across the different studies precluding a meta-analysis. Four themes emerged from the thematic analysis of the selected papers: physical well-being (including fitness and symptoms); psychological well-being (including anxiety and depression); social well-being (including family life and relationships); and functional status (including return to work and previous life style). Physical domain outcomes suggest that cardiac rehabilitation may improve physical well-being and levels of physical activity and thereby improved levels of physical fitness. Both physical and psychological domain outcomes suggest that home-based interventions are at least as effective as centre-based interventions. Relatively few trials reported on quality of life within the social domain and any difference between centre-based and home-based interventions appeared to favour the home-based intervention.
This review indicates that cardiac rehabilitation improves the quality of life for coronary heart disease patients and that quality of life improvements have a bi-directional relationship with increased physical activity and vocational status. Further research is needed to explore the relationship of quality of life outcomes to cardiac mortality, the relationship between improved physical well-being and anxiety, and the quality of life and mortality effects of cardiac rehabilitation in older people.
本系统评价的目的是探讨心脏康复干预对冠心病患者生活质量的影响，尤其关注那些可以在公共资助的卫生服务背景下实施的干预措施。
对报告生活质量数据作为结局指标的试验进行系统评价。从 1999 年 1 月 1 日至 2010 年 11 月 25 日，在英文电子数据库（CINAHL、MEDLINE 和 PsycINFO）中进行检索。纳入标准为：以公共资助的卫生服务为配置的心脏康复随机对照试验。由一名评审员提取数据，另一名评审员进行核对。
16 篇论文报告了在 9 个国家进行的 RCT。15 种测量工具被用于评估不同研究中的生活质量，因此无法进行荟萃分析。从入选论文的主题分析中得出 4 个主题：身体状况（包括健康和症状）；心理状况（包括焦虑和抑郁）；社会状况（包括家庭生活和关系）；以及功能状态（包括重返工作岗位和以前的生活方式）。身体领域的结果表明，心脏康复可能改善身体状况和身体活动水平，从而提高身体的健康水平。身体和心理领域的结果均表明，家庭干预与中心干预同样有效。相对较少的试验报告了社会领域的生活质量，且中心干预和家庭干预之间的任何差异似乎都有利于家庭干预。
本综述表明，心脏康复可改善冠心病患者的生活质量，生活质量的改善与身体活动和职业状况的增加呈双向关系。需要进一步研究以探讨生活质量结局与心脏死亡率之间的关系、身体状况改善与焦虑之间的关系，以及老年人心脏康复的生活质量和死亡率效应。
