Emory University School of Medicine, 1462 Clifton Road NE, Suite 502, Atlanta, GA 30322, USA.
Circulation. 2012 Sep 25;126(13):1587-95. doi: 10.1161/CIRCULATIONAHA.111.088799. Epub 2012 Aug 28.
Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) is a Class I recommendation. Although referral to CR after an AMI has recently become a performance measure, many patients may not participate. To illuminate potential barriers to participation, we examined the prevalence of, and patient-related factors associated with, CR participation within 1 and 6 months after an AMI.
We studied 2096 AMI patients enrolled from 19 US sites in the Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery (PREMIER) registry. Analyses were limited to those patients referred for CR at the time of AMI hospitalization. A multivariable, conditional logistic regression model, stratified by hospital, was used to identify sociodemographic, comorbidity, and clinical factors independently associated with CR participation within 1 and 6 months of AMI hospital discharge. Only 29% (419/1450) and 48.25% (650/1347) of AMI patients who received referral for CR participated within 1 and 6 months after discharge, respectively. Women (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.44-0.86), uninsured (OR, 0.39; 95% CI, 0.21-0.71), and patients with hypertension (OR, 0.58; 95% CI, 0.43-0.78) and peripheral arterial disease (OR, 0.43; 95% CI, 0.22-0.85) were less likely to participate at 1 month. At 6 months after AMI, older patients (OR, 0.85 for each 10-year increment; 95% CI, 0.74-0.97), smokers (OR, 0.59; 95% CI, 0.44-0.80), and patients with economic burden (OR, 0.56; 95% CI, 0.38-0.81) were less likely to participate. Caucasians (OR, 1.73; 95% CI, 1.16-2.58) and educated patients (OR, 1.81; 95% CI, 1.42-2.30) were more likely to participate at 6 months. Patients with previous percutaneous interventions were less likely to participate at both 1 and 6 months post-AMI.
Among patients referred for CR post-AMI, participation remains low both at 1 and 6 months after AMI. Because CR is associated with beneficial changes in cardiovascular risk factors and better outcomes after AMI, more aggressive efforts are needed to increase CR participation after referral.
急性心肌梗死（AMI）后的心脏康复（CR）是 I 类推荐。尽管最近将 AMI 后转介至 CR 已成为一项绩效衡量标准，但许多患者可能无法参与。为了阐明参与的潜在障碍，我们检查了 AMI 后 1 个月和 6 个月内 CR 参与的发生率，以及与患者相关的因素。
我们研究了 2096 名来自美国 19 个地点的 Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery（PREMIER）登记处的 AMI 患者。分析仅限于在 AMI 住院期间转介至 CR 的患者。采用多变量条件逻辑回归模型，按医院分层，确定与 AMI 出院后 1 个月和 6 个月内 CR 参与相关的社会人口统计学、合并症和临床因素。只有 29%（419/1450）和 48.25%（650/1347）接受 CR 转介的 AMI 患者在出院后 1 个月和 6 个月内分别参与了 CR。女性（比值比[OR]，0.61；95%置信区间[CI]，0.44-0.86）、未参保（OR，0.39；95%CI，0.21-0.71）、高血压（OR，0.58；95%CI，0.43-0.78）和外周动脉疾病（OR，0.43；95%CI，0.22-0.85）患者不太可能在 1 个月时参与。在 AMI 后 6 个月时，年龄较大的患者（每增加 10 岁，OR 为 0.85；95%CI，0.74-0.97）、吸烟者（OR，0.59；95%CI，0.44-0.80）和有经济负担的患者（OR，0.56；95%CI，0.38-0.81）不太可能参与。白种人（OR，1.73；95%CI，1.16-2.58）和受过教育的患者（OR，1.81；95%CI，1.42-2.30）在 6 个月时更有可能参与。在 1 个月和 6 个月时，有经皮介入治疗史的患者不太可能参与。
在转介至 CR 的 AMI 患者中，1 个月和 6 个月后参与率仍然很低。由于 CR 与 AMI 后心血管风险因素的有益变化和更好的结果相关，因此需要更积极地努力增加 CR 参与度。
