Melamed Richard J, Tillmann Alexander, Kufleitner Heidrun-Eva, Thürmer Uwe, Dürsch Martin
Tillmann have equally contributed to the article, Department of Medicine, Goethe University Frankfurt/Main, Studiumdigitale-E-Learning Center, Goethe University Frankfurt/Main, Bürgerhospital, Frankfurt am Main, Praxis Thürmer/Endruleit, Frankfurt am Main, Cardiology Frankfurt-Sachsenhausen, Frankfurt am Main.
Dtsch Arztebl Int. 2014 Nov 21;111(47):802-8. doi: 10.3238/arztebl.2014.0802.
Until now, there has not been any evaluated, disease-specific education and treatment program for patients with coronary heart disease (CHD) in Germany. It is thought that education can improve these patients' physical activity and quality of life and teach them how to lessen their risk factors, what to do in case of an emergency, and how to assess their own medical treatment.
A randomized controlled open intervention trial was carried out from February 2010 to September 2011. 196 patients were assigned to receive the intervention (patient education), while 199 were assigned to a control group. In an intention-to-treat analysis, baseline and follow-up data were compared after a mean interval of 220 days. The evaluative instruments included the Freiburg Questionnaire of Physical Activity, the MacNew Heart Disease Quality of Life Questionnaire, questionnaires regarding knowledge about CHD, ergometric performance ability, and the body-mass index.
The patients in the intervention group reported having increased their physical activity by a mean of 9.3 MET/week (MET=metabolic equivalent of task), compared to 2.5 MET/week in the control group; the difference of 6.8 MET/week was statistically significant (p = 0.015). The patients in the intervention group also rated their quality of life higher than those in the control group (0.2 ± 0.56 vs. 0.09 ± 0.53 [mean ± standard deviation], p = 0.056). They were significantly better informed than patients in the control group about risk factors and about what to do in an emergency.
Persistently unhealthy lifestyle is a common problem of CHD patients; the education and treatment program presented here may be a suitable means of improving patients' lifestyle for secondary prevention. Further studies will be needed to document long-term efficacy and to determine whether occasional refresher courses will be needed as well.
到目前为止，德国尚未有针对冠心病（CHD）患者的经过评估的、针对特定疾病的教育和治疗项目。人们认为，教育可以改善这些患者的身体活动和生活质量，并教会他们如何降低风险因素、在紧急情况下该怎么做以及如何评估自己的医疗治疗。
2010年2月至2011年9月进行了一项随机对照开放干预试验。196名患者被分配接受干预（患者教育），而199名患者被分配到对照组。在意向性分析中，平均间隔220天后比较基线和随访数据。评估工具包括弗莱堡身体活动问卷、麦克纽心脏病生活质量问卷、关于冠心病知识的问卷、运动能力测试和体重指数。
干预组患者报告其身体活动平均每周增加9.3代谢当量（MET，代谢当量=任务的代谢当量），而对照组为每周2.5 MET；每周6.8 MET的差异具有统计学意义（p = 0.015）。干预组患者对生活质量的评分也高于对照组（0.2±0.56对0.09±0.53[平均值±标准差]，p = 0.056）。他们比对照组患者在风险因素以及紧急情况下该怎么做方面的了解明显更好。
持续不健康的生活方式是冠心病患者的常见问题；这里介绍的教育和治疗项目可能是改善患者生活方式以进行二级预防的合适手段。还需要进一步的研究来记录长期疗效，并确定是否也需要偶尔的复习课程。
