Schlitt Axel, Wischmann Patricia, Wienke Andreas, Hoepfner Florian, Noack Frank, Silber Rolf-Edgar, Werdan Karl
Paracelsus Harz Clinic Bad Suderode, Quedlinburg, Department of Internal Medicine III, University Hospital of Halle (Saale), Institute for Medical Epidemiology, Biometrics and Computer Science, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Department of Internal Medicine I, University Hospital of Halle (Saale), Department of Cardiac und Thoracic Surgery, University Hospital of Halle (Saale).
Dtsch Arztebl Int. 2015 Aug 3;112(31-32):527-34. doi: 10.3238/arztebl.2015.0527.
In Germany, rehabilitation is considered to be indicated after an acute hospital stay for the treatment of a severe cardiac condition. In comparative studies, at least 51% of German hospital patients with coronary heart disease (CHD) who were entitled to rehabilitative measures actually took part n rehabilitation.
We examined data on 1910 patients with CHD who took part in two prospective cohort studies at the University Hospital of Halle (Saale) in the years 2007-2011. We contacted these patients again with a questionnaire to determine which ones had undergone rehabilitation. For patients who died before we could contact them, the attempt was made to obtain the dates and causes of death from the local authorities. The primary endpoint of was overall mortality.
The median duration of follow-up was 136 ± 71 weeks. 727 patients (38.1%) had applied for rehabilitation during their acute hospitalization, but only 552 patients (28.9%) actually underwent it. Patients who did not undergo rehabilitation were older than those who did (68.6 ± 10.3 vs. 64.9 ± 10.5 years) and suffered more commonly from diabetes (41.3% vs. 33.7%; p = 0.002), arterial hypertension (89.2% vs. 85.3%; p = 0.017), and peripheral arterial occlusive disease (15.3% vs. 9.8%; p = 0.002). There were more smokers in the rehabilitation group. Kaplan-Meier analysis and multivariate Cox regression analysis both showed that the patients who underwent rehabilitation had lower mortality (hazard ratio 0.067, 95% confidence interval 0.025-0.180, p < 0.001).
Rehabilitation for cardiac patients was associated with lower mortality. Fewer patients underwent rehabilitation in this study than in other, comparable studies. Those who did not were older and had a greater burden of accompanying disease.
在德国，对于严重心脏疾病患者，急性住院治疗后会考虑进行康复治疗。在比较研究中，至少51%有权接受康复治疗的德国冠心病（CHD）住院患者实际参与了康复治疗。
我们研究了2007年至2011年期间在哈雷（萨勒）大学医院参与两项前瞻性队列研究的1910例冠心病患者的数据。我们再次通过问卷调查联系这些患者，以确定哪些患者接受了康复治疗。对于在我们能够联系他们之前死亡的患者，尝试从当地政府获取死亡日期和原因。主要终点是总死亡率。
随访的中位持续时间为136±71周。727例患者（38.1%）在急性住院期间申请了康复治疗，但只有552例患者（28.9%）实际接受了康复治疗。未接受康复治疗的患者比接受康复治疗的患者年龄更大（68.6±10.3岁对64.9±10.5岁），更常患有糖尿病（41.3%对33.7%；p = 0.002）、动脉高血压（89.2%对85.3%；p = 0.017）和外周动脉闭塞性疾病（15.3%对9.8%；p = 0.002）。康复组吸烟者更多。Kaplan-Meier分析和多变量Cox回归分析均显示，接受康复治疗的患者死亡率较低（风险比0.067，95%置信区间0.025 - 0.180，p < 0.001）。
心脏病患者的康复治疗与较低的死亡率相关。本研究中接受康复治疗的患者少于其他类似研究。未接受康复治疗的患者年龄更大，伴随疾病负担更重。
