Kureshi Faraz, Kennedy Kevin F, Jones Philip G, Thomas Randal J, Arnold Suzanne V, Sharma Praneet, Fendler Timothy, Buchanan Donna M, Qintar Mohammed, Ho P Michael, Nallamothu Brahmajee K, Oldridge Neil B, Spertus John A
Division of Cardiovascular Diseases and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri2School of Medicine, University of Missouri-Kansas City.
Division of Cardiovascular Diseases and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
JAMA Cardiol. 2016 Dec 1;1(9):980-988. doi: 10.1001/jamacardio.2016.3458.
Cardiac rehabilitation (CR) improves survival after acute myocardial infarction (AMI), and referral to CR has been introduced as a performance measure of high-quality care. The association of participation in CR with patients' health status (eg, quality of life, symptoms, and functional status) is poorly defined.
To examine the association of participation in CR with health status outcomes after AMI.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted of patients enrolled in 2 AMI registries: PREMIER, from January 1, 2003, to June 28, 2004, and TRIUMPH, from April 11, 2005, to December 31, 2008. The analytic cohort was restricted to 4929 patients with data available on baseline health status, 6- or 12- month follow-up health status, and participation in CR. Data analysis was performed from 2014 to 2015.
Participation in at least 1 CR session within 6 months of hospital discharge.
Patient health status was quantified using the Seattle Angina Questionnaire (SAQ) and the 12-Item Short-Form Health Survey (SF-12). The primary outcomes of interest were the mean differences in SAQ domain scores during the 12 months after AMI between patients who did and did not participate in CR. Secondary outcomes were the mean differences in the SF-12 summary scores and all-cause mortality.
After successfully matching the cohorts of the 4929 patients (3328 men and 1601 women; mean [SD] age, 60.0 [12.2] years) for the propensity to participate in CR and comparing the groups using linear, mixed-effects models, mean differences in the SAQ and SF-12 domain scores were similar at 6 and 12 months between the 2012 patients participating in CR (3 were unable to be matched) and the 2894 who did not participate (20 were unable to be matched). At 6 months, the mean difference was -0.76 (95% CI, -2.05 to 0.52) for the SAQ quality of life score, -1.53 (95% CI, -2.57 to -0.49) for the SAQ angina frequency score, 0.38 (95% CI, -0.51 to 1.27) for the SAQ treatment satisfaction score, -0.42 (95% CI, -1.65 to 0.79) for the SAQ physical limitation score, 0.50 (95% CI, -0.22 to 1.22) for the SF-12 physical component score, and 0.13 (95% CI, -0.53 to 0.79) for the SF-12 mental component score. At 12 months, the mean difference was -0.89 (95% CI, -2.20 to 0.43) for the SAQ quality of life score, -1.05 (95% CI, -2.12 to 0.02) for the SAQ angina frequency score, 0.38 (95% CI, -0.54 to 1.29) for the SAQ treatment satisfaction score, -0.14 (95% CI, -1.41 to 1.14) for the SAQ physical limitation score, 0.17 (95% CI, -0.57 to 0.92) for the SF-12 physical component score, and 0.12 (95% CI, -0.56 to 0.80) for the SF-12 mental component score. In contrast, the hazard rate of all-cause mortality (up to 7 years) associated with participating in CR was 0.59 (95% CI, 0.46-0.75).
In a cohort of 4929 patients with AMI, we found that those who did and did not participate in CR had similar reported health status during the year following AMI; however, participation in CR did confer a significant survival benefit. These findings underscore the need for increased use of validated patient-reported outcome measures to further examine if and how health status can be maximized for patients who participate in CR.
心脏康复（CR）可提高急性心肌梗死（AMI）后的生存率，将患者转诊至心脏康复已被引入作为高质量医疗的一项绩效指标。参与心脏康复与患者健康状况（如生活质量、症状和功能状态）之间的关联尚不明确。
研究参与心脏康复与急性心肌梗死后健康状况结局之间的关联。
设计、设置和参与者：对纳入两个急性心肌梗死登记处的患者进行了一项回顾性队列研究：2003年1月1日至2004年6月28日的PREMIER登记处，以及2005年4月11日至2008年12月31日的TRIUMPH登记处。分析队列仅限于4929例具有基线健康状况、6个月或12个月随访健康状况以及参与心脏康复数据的患者。数据分析于2014年至2015年进行。
出院后6个月内参与至少1次心脏康复疗程。
使用西雅图心绞痛问卷（SAQ）和12项简明健康调查（SF - 12）对患者健康状况进行量化。感兴趣的主要结局是急性心肌梗死后12个月内参与和未参与心脏康复的患者之间SAQ各领域得分的平均差异。次要结局是SF - 12总结得分的平均差异和全因死亡率。
在成功匹配4929例患者（3328名男性和1601名女性；平均[标准差]年龄，60.0[12.2]岁）参与心脏康复的倾向并使用线性混合效应模型对组间进行比较后，2012例参与心脏康复的患者（3例无法匹配）和2894例未参与心脏康复的患者（20例无法匹配）在6个月和12个月时SAQ和SF - 12各领域得分的平均差异相似。在6个月时，SAQ生活质量得分的平均差异为 - 0.76（95%置信区间， - 2.05至0.52），SAQ心绞痛频率得分的平均差异为 - 1.53（95%置信区间， - 2.57至 - 0.49），SAQ治疗满意度得分的平均差异为0.38（95%置信区间， - 0.51至1.27），SAQ身体限制得分的平均差异为 - 0.42（95%置信区间， - 1.65至0.79），SF - 12身体成分得分的平均差异为0.50（95%置信区间， - 0.22至1.22），SF - 12精神成分得分的平均差异为0.13（95%置信区间， - 0.53至0.79）。在12个月时，SAQ生活质量得分的平均差异为 - 0.89（95%置信区间， - 2.20至0.43），SAQ心绞痛频率得分的平均差异为 - 1.05（95%置信区间
