Department of Medicine, University of Virginia, Charlottesville, VA.
Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
J Am Heart Assoc. 2017 Dec 29;7(1):e007664. doi: 10.1161/JAHA.117.007664.
Participation in cardiac rehabilitation (CR) after acute myocardial infarction has been proven to significantly reduce morbidity and mortality. Historically, participation rates have been low, and although recent efforts have increased referral rates, current data on CR participation are limited.
Utilizing data from the Behavioral Risk Factor Surveillance System conducted by Centers for Disease Control and Prevention, we performed a population-based, cross-sectional analysis of CR post-acute myocardial infarction. Unadjusted participation from 2005 to 2015 was evaluated by univariable logistic regression. Multivariable logistic regression was performed with patient characteristic variables to determine adjusted trends and associations with participation in CR in more recent years from 2011 to 2015. Among the 32 792 survey respondents between 2005 and 2015, participation ranged from 35% in 2005 to 39% in 2009 (=0.005) and from 38% in 2011 to 32% in 2015 (=0.066). Between 2011 and 2015, participants were less likely to be female (odds ratio [OR] 0.763, 95% confidence interval [CI] 0.646-0.903), black (OR 0.700, 95% CI 0.526-0.931), uninsured (OR 0.528, 95% CI 0.372-0.751), less educated (OR 0.471, 95% CI 0.367-0.605), current smokers (OR 0.758, 95% CI 0.576-0.999), and were more likely to be retired or self-employed (OR 1.393, 95% CI 1.124-1.726).
Only one third of patients participate in CR following acute myocardial infarction despite the known health benefits. Participants are less likely to be female, black, and uneducated. Future studies should focus on methods to maximize the proportion of CR referrals converted into CR participation.
参与心脏康复（CR）已被证明可显著降低急性心肌梗死后的发病率和死亡率。尽管近年来已经增加了转诊率，但历史上的参与率一直较低，目前关于 CR 参与的数据有限。
我们利用疾病控制与预防中心（Centers for Disease Control and Prevention）开展的行为风险因素监测系统（Behavioral Risk Factor Surveillance System）的数据，对急性心肌梗死后的 CR 进行了一项基于人群的横断面分析。利用单变量逻辑回归评估了 2005 年至 2015 年未经调整的参与率。利用患者特征变量进行多变量逻辑回归，以确定近年来（2011 年至 2015 年） CR 参与的调整趋势和关联。在 2005 年至 2015 年的 32792 名调查受访者中，参与率从 2005 年的 35%波动至 2009 年的 39%（=0.005）和 2011 年的 38%波动至 2015 年的 32%（=0.066）。2011 年至 2015 年期间，参与者中女性（比值比[OR]0.763，95%置信区间[CI]0.646-0.903）、黑人（OR0.700，95%CI0.526-0.931）、无保险（OR0.528，95%CI0.372-0.751）、受教育程度较低（OR0.471，95%CI0.367-0.605）、当前吸烟者（OR0.758，95%CI0.576-0.999）的比例较低，退休或自营职业者（OR1.393，95%CI1.124-1.726）的比例较高。
尽管已知心脏康复有健康益处，但仅有三分之一的患者在急性心肌梗死后参与心脏康复。参与者中女性、黑人、受教育程度较低的比例较低。未来的研究应集中于方法，以最大限度地提高心脏康复转诊转化为心脏康复参与的比例。
