Sharma Rajat, Norris Colleen M, Gyenes Gabor, Senaratne Manohara, Bainey Kevin R
Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
Grey Nuns Hospital, University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2016 Oct;32(10 Suppl 2):S397-S402. doi: 10.1016/j.cjca.2016.05.012. Epub 2016 May 27.
Unequivocally, cardiac rehabilitation (CR) in patients with established cardiovascular disease improves survival. However, its effect on higher-risk ethnic groups has not been explored. Accordingly, we evaluated the effect of CR on South Asian (SA) compared with European Canadians with coronary artery disease (CAD).
Using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry, 26,167 patients from Edmonton, Alberta who received coronary angiography with documented CAD were reviewed (January 2002 to March 2012). After excluding Chinese patients, 1027 SA patients were compared with 11,992 European Canadian patients using validated surname algorithms. Adjustment was performed using a Cox proportional hazard model.
Of the SA cohort, 50.6% attended CR, compared with 43.0% of the European Canadian cohort (P < 0.001). After adjustment, CR was associated with long-term survival irrespective of ethnic group (total study population: hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.52-0.63; P < 0.001; SA population: HR, 0.63; 95% CI, 0.40-0.99; P = 0.045; European population: HR, 0.57; 95% CI, 0.52-0.63; P < 0.001). When comparing SA vs European Canadians attending CR, improved survival was observed in SA patients (HR, 0.58; 95% CI, 0.40-0.85; P < 0.001). This benefit appeared limited to SA patients who completed CR (complete CR: HR, 0.37; 95% CI, 0.17-0.85; P = 0.02; incomplete CR: HR, 0.78; 95% CI, 0.45-1.35; P = 0.38).
Overall, referral rates to CR remains low but attendance appears higher in SA patients. Among those who attended CR, there is a strong association with improved survival irrespective of ethnic status. In SA patients with CAD, attendance and completion of CR should be strongly endorsed because of its incremental benefit.
毫无疑问，已确诊心血管疾病患者的心脏康复（CR）可提高生存率。然而，其对高危种族群体的影响尚未得到研究。因此，我们评估了CR对南亚（SA）冠心病（CAD）患者的影响，并与加拿大欧洲裔患者进行了比较。
利用艾伯塔省冠心病结局评估省级项目（APPROACH）登记处的数据，对来自艾伯塔省埃德蒙顿市的26167例接受冠状动脉造影且确诊为CAD的患者进行了回顾（2002年1月至2012年3月）。在排除中国患者后，使用经过验证的姓氏算法，将1027例SA患者与11992例加拿大欧洲裔患者进行了比较。采用Cox比例风险模型进行调整。
SA队列中，50.6%的患者参加了CR，而加拿大欧洲裔队列中的这一比例为43.0%（P<0.001）。调整后，无论种族如何，CR均与长期生存相关（总研究人群：风险比[HR]，0.57；95%置信区间[CI]，0.52 - 0.63；P<0.001；SA人群：HR，0.63；95%CI，0.40 - 0.99；P = 0.045；欧洲人群：HR，0.57；95%CI，0.52 - 0.63；P<0.001）。比较参加CR的SA患者和加拿大欧洲裔患者时，观察到SA患者的生存率有所提高（HR，0.58；95%CI，0.40 - 0.85；P<0.001）。这种益处似乎仅限于完成CR的SA患者（完成CR：HR，0.37；95%CI，0.17 - 0.85；P = 0.02；未完成CR：HR，0.78；95%CI，0.45 - 1.35；P = 0.38）。
总体而言，CR的转诊率仍然较低，但SA患者的参与率似乎较高。在参加CR的患者中，无论种族状况如何，生存率的提高都有很强的相关性。对于患有CAD的SA患者，应大力支持其参与并完成CR，因为这会带来额外的益处。
