Gaalema Diann E, Savage Patrick D, Rengo Jason L, Cutler Alex Y, Elliott Rebecca J, Priest Jeffrey S, Higgins Stephen T, Ades Philip A
Vermont Center on Behavior and Health, Burlington (Drs Gaalema, Higgins, and Ades, Mr Cutler, and Ms Elliott); Departments of Psychiatry (Drs Gaalema and Higgins, Mr Cutler, and Ms Elliott), Psychology (Drs Gaalema and Higgins), and Medical Biostatistics (Mr Savage and Rengo and Dr Ades), University of Vermont, Burlington; and Department of Medicine, University of Vermont Medical Center, Burlington (Dr Priest).
J Cardiopulm Rehabil Prev. 2017 Mar;37(2):103-110. doi: 10.1097/HCR.0000000000000225.
Cardiac rehabilitation (CR) is a program of structured exercise and interventions for coronary risk factor reduction that reduces morbidity and mortality rates following a major cardiac event. Although a dose-response relationship between the number of CR sessions completed and health outcomes has been demonstrated, adherence with CR is not high. In this study, we examined associations between the number of sessions completed within CR and patient demographics, clinical characteristics, smoking status, and socioeconomic status (SES).
Multiple logistic regression and classification and regression tree (CART) modeling were used to examine associations between participant characteristics measured at CR intake and the number of sessions completed in a prospectively collected CR clinical database (n = 1658).
Current smoking, lower SES, nonsurgical diagnosis, exercise-limiting comorbidities, and lower age independently predicted fewer sessions completed. The CART analysis illustrates how combinations of these characteristics (ie, risk profiles) predict the number of sessions completed. Those with the highest-risk profile for nonadherence (<65 years old, current smoker, lower SES) completed on average 9 sessions while those with the lowest-risk profile (>72 years old, not current smoker, higher SES, surgical diagnosis) completed 27 sessions on average.
Younger individuals, as well as those who report smoking or economic challenges or have a nonsurgical diagnosis, may require additional support to maintain CR session attendance.
心脏康复(CR)是一项旨在通过有组织的运动和干预措施来降低冠状动脉危险因素的项目,可降低重大心脏事件后的发病率和死亡率。尽管已证实完成的CR疗程数量与健康结果之间存在剂量反应关系,但CR的依从性并不高。在本研究中,我们探讨了在CR项目中完成的疗程数量与患者人口统计学特征、临床特征、吸烟状况和社会经济地位(SES)之间的关联。
使用多元逻辑回归和分类与回归树(CART)建模,来研究在CR项目开始时测量的参与者特征与在前瞻性收集的CR临床数据库(n = 1658)中完成的疗程数量之间的关联。
当前吸烟、较低的SES、非手术诊断、限制运动的合并症以及较低的年龄独立预测了完成的疗程数量较少。CART分析说明了这些特征(即风险概况)的组合如何预测完成的疗程数量。依从性风险最高的人群(<65岁,当前吸烟者,较低的SES)平均完成9个疗程,而依从性风险最低的人群(>72岁,非当前吸烟者,较高的SES,手术诊断)平均完成27个疗程。
年轻人,以及那些报告有吸烟或经济困难情况或有非手术诊断的人,可能需要额外的支持来维持CR疗程的参与。