Matata Bashir M, Williamson Sean Andrew
Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool, L14 3PE. United Kingdom.
Liverpool Heart & Chest Hospital, Liverpool. United Kingdom.
Curr Cardiol Rev. 2017;13(4):252-262. doi: 10.2174/1574884712666170710094842.
This review provides an overview and quality assessment of existing interventions, assessing the intervention types that are most effective at increasing enrolment and adherence to cardiac rehabilitation in older patients aged ≥65 years Methods: The review of the literature was performed using electronic databases to search for randomised controlled trials that aimed to increase enrolment and/or adherence to cardiac rehabilitation in older patients aged ≥65 years. The main key words were cardiac rehabilitation, enrolment, adherence and older patients. Studies were included if; (1) the intervention targeted improving enrolment and/or adherence to at least one of the following components of the cardiac rehabilitation programme: exercise, education or maintaining lifestyle changes; (2) assess the effectiveness of an intervention on increasing enrolment and/or adherence to a cardiac rehabilitation programme or any of its components; (3) include measures for assessing enrolment and/or adherence to a cardiac rehabilitation programme or any of its components; (4) the study included patients with a mean age of ≥65 years who were deemed eligible to participate in a cardiac rehabilitation programme. Included studies could be published in any language and there were no date restrictions for included studies. Studies focusing on pharmaceutical adherence were not included for the purpose of this review.
Seven studies were included, with four investigating enrolment (1944 participants) and three assessing adherence to intervention programmes (410 participants). Three studies (1919 participants) reported higher enrolment to cardiac rehabilitation in the intervention group. Two studies that reported increases in enrolment to cardiac rehabilitation were deemed to have an unclear or high risk of bias. All three studies (410 participants) reported better adherence to cardiac rehabilitation in the intervention group when compared to the control group. Two studies that reported better completion of cardiac rehabilitation were deemed to have an unclear or high risk of bias. No formal meta-analysis was conducted due to the observed multiple heterogeneity among outcome measures, the low number of included studies and variability in study designs.
This review found only weak evidence to suggest that interventions can increase enrolment or adherence to cardiac rehabilitation programmes for patients aged ≥65 years, therefore no practice recommendations could be made and further high-quality research is needed in this population group.
本综述对现有干预措施进行概述和质量评估，评估在≥65岁老年患者中最有效地提高心脏康复参与率和依从性的干预类型。方法：通过电子数据库对文献进行综述，以检索旨在提高≥65岁老年患者心脏康复参与率和/或依从性的随机对照试验。主要关键词为心脏康复、参与率、依从性和老年患者。纳入研究需满足以下条件：（1）干预旨在改善心脏康复计划中至少以下一个组成部分的参与率和/或依从性：运动、教育或维持生活方式改变；（2）评估干预对提高心脏康复计划或其任何组成部分的参与率和/或依从性的有效性；（3）包括评估心脏康复计划或其任何组成部分的参与率和/或依从性的措施；（4）研究纳入平均年龄≥65岁且被认为有资格参加心脏康复计划的患者。纳入研究可以以任何语言发表，且对纳入研究没有日期限制。本综述不纳入专注于药物依从性的研究。
纳入七项研究，四项研究调查参与率（1944名参与者），三项研究评估对干预计划的依从性（410名参与者）。三项研究（1919名参与者）报告干预组心脏康复参与率更高。两项报告心脏康复参与率增加的研究被认为存在不明确或高偏倚风险。与对照组相比，所有三项研究（410名参与者）均报告干预组对心脏康复的依从性更好。两项报告心脏康复完成情况更好的研究被认为存在不明确或高偏倚风险。由于观察到结局指标存在多种异质性、纳入研究数量少以及研究设计存在差异，未进行正式的荟萃分析。
本综述仅发现微弱证据表明干预措施可提高≥65岁患者心脏康复计划的参与率或依从性，因此无法提出实践建议，该人群组需要进一步的高质量研究。
