Benzer Werner, Rauch Bernhard, Schmid Jean-Paul, Zwisler Ann Dorthe, Dendale Paul, Davos Constantinos H, Kouidi Evangelia, Simon Attila, Abreu Ana, Pogosova Nana, Gaita Dan, Miletic Bojan, Bönner Gerd, Ouarrak Taoufik, McGee Hannah
Reha Sports Institute and Case Management Centre, Feldkirch, Austria.
Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Int J Cardiol. 2017 Feb 1;228:58-67. doi: 10.1016/j.ijcard.2016.11.059. Epub 2016 Nov 11.
Results from EuroCaReD study should serve as a benchmark to improve guideline adherence and treatment quality of cardiac rehabilitation (CR) in Europe.
Data from 2.054 CR patients in 12 European countries were derived from 69 centres. 76% were male. Indication for CR differed between countries being predominantly ACS in Switzerland (79%), Portugal (62%) and Germany (61%), elective PCI in Greece (37%), Austria (36%) and Spain (32%), and CABG in Croatia and Russia (36%). A minority of patients presented with chronic heart failure (4%). At CR start, most patients already were under medication according to current guidelines for the treatment of CV risk factors. A wide range of CR programme designs was found (duration 3 to 24weeks; total number of sessions 30 to 196). Patient programme adherence after admission was high (85%). With reservations that eCRF follow-up data exchange remained incomplete, patient CV risk profiles experienced only small improvements. CR success as defined by an increase of exercise capacity >25W was significantly higher in young patients and those who were employed. Results differed by countries. After CR only 9% of patients were admitted to a structured post-CR programme.
Clinical characteristics of CR patients, indications and programmes in Europe are different. Guideline adherence is poor. Thus, patient selection and CR programme designs should become more evidence-based. Routine eCRF documentation of CR results throughout European countries was not sufficient in its first application because of incomplete data exchange. Therefore better adherence of CR centres to minimal routine clinical standards is requested.
欧洲心脏康复数据(EuroCaReD)研究结果应作为提高欧洲心脏康复(CR)指南依从性和治疗质量的基准。
来自欧洲12个国家69个中心的2054例CR患者的数据。76%为男性。各国CR的适应症有所不同,在瑞士(79%)、葡萄牙(62%)和德国(61%)主要为急性冠状动脉综合征(ACS),在希腊(37%)、奥地利(36%)和西班牙(32%)为择期经皮冠状动脉介入治疗(PCI),在克罗地亚和俄罗斯为冠状动脉旁路移植术(CABG)(36%)。少数患者表现为慢性心力衰竭(4%)。在CR开始时,大多数患者已经按照当前心血管危险因素治疗指南接受药物治疗。发现了广泛的CR项目设计(持续时间3至24周;总疗程30至196次)。入院后患者对项目的依从性较高(85%)。尽管电子病例报告表(eCRF)随访数据交换仍不完整,但患者的心血管风险状况仅有小幅改善。以运动能力增加>25瓦定义的CR成功率在年轻患者和就业患者中显著更高。结果因国家而异。CR后仅有9%的患者进入结构化的CR后项目。
欧洲CR患者的临床特征、适应症和项目各不相同。指南依从性较差。因此,患者选择和CR项目设计应更基于证据。由于数据交换不完整,欧洲各国CR结果的常规eCRF记录在首次应用时并不充分。因此,要求CR中心更好地遵守最低常规临床标准。