Brawner Clinton A, Girdano Daniel, Ehrman Jonathan K, Keteyian Steven J
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan (Drs Brawner, Ehrman, and Keteyian); and College of Health Sciences, Walden University, Minneapolis, Minnesota (Drs Brawner and Girdano).
J Cardiopulm Rehabil Prev. 2017 Mar;37(2):111-118. doi: 10.1097/HCR.0000000000000201.
There is an inverse relationship between phase 2 cardiac rehabilitation (CR) visits and all-cause mortality. Phase 3 CR is a maintenance exercise program for which clinical outcomes are uncertain. This retrospective study describes the association between phase 3 CR participation and clinical events among patients with ischemic heart disease after completion of phase 2 CR.
Patients who completed 12 visits of phase 2 CR as provided by their health insurance were categorized on the basis of their frequency of participation (ie, none, irregular, and regular) in phase 3 CR during the 8 weeks after phase 2 CR. Cox regression analysis was used to evaluate the association between phase 3 CR participation and risk for a composite outcome that included all-cause mortality, nonfatal myocardial infarction, or heart failure hospitalization.
Among 2039 patients (32% women; age = 59 ± 10 years) who completed phase 2 CR, 101 were regular and 129 were irregular participants of phase 3 CR. Over a median followup of 5.6 years, 556 (27%) patients experienced the outcome. Neither irregular nor regular participation in phase 3 CR was significantly associated with risk for the outcome in unadjusted (P = .671 and P = .396, respectively) or adjusted (P = .737 and P = .890, respectively) analyses.
We did not observe an incremental clinical benefit from weekly participation in Phase 3 CR after completion of phase 2 CR among patients with ischemic heart disease. Additional research addressing the dose-response relationship between phase 2 and 3 CR and clinical outcomes is needed.
心脏康复（CR）第二阶段的就诊次数与全因死亡率呈负相关。第三阶段的CR是一项维持性运动计划，其临床结局尚不确定。这项回顾性研究描述了缺血性心脏病患者在完成第二阶段CR后，参与第三阶段CR与临床事件之间的关联。
完成由其健康保险提供的12次第二阶段CR就诊的患者，根据他们在第二阶段CR后的8周内参与第三阶段CR的频率（即无、不规律和规律）进行分类。采用Cox回归分析来评估参与第三阶段CR与包括全因死亡率、非致命性心肌梗死或心力衰竭住院在内的复合结局风险之间的关联。
在完成第二阶段CR的2039名患者（32%为女性；年龄=59±10岁）中，101名是第三阶段CR的规律参与者，129名是不规律参与者。在中位随访5.6年期间，556名（27%）患者出现了该结局。在未调整分析（分别为P = 0.671和P = 0.396）或调整分析（分别为P = 0.737和P = 0.890）中，参与第三阶段CR的不规律或规律情况均与该结局风险无显著关联。
在缺血性心脏病患者完成第二阶段CR后，我们未观察到每周参与第三阶段CR能带来额外的临床益处。需要开展更多研究来探讨第二阶段和第三阶段CR之间的剂量反应关系及其与临床结局的关系。
