Department of Medicine, University of California San Francisco, San Francisco, California; San Francisco Veterans Affairs Medical Center, San Francisco, California.
Department of Medicine, University of California San Francisco, San Francisco, California.
Am J Cardiol. 2019 Jan 1;123(1):19-24. doi: 10.1016/j.amjcard.2018.09.024. Epub 2018 Sep 26.
Traditional, facility-based cardiac rehabilitation (CR) is vastly underutilized in the United States. The Veterans Health Administration (VA) has developed new home-based cardiac rehabilitation (HBCR) programs to address this issue. However, the characteristics of patients who choose HBCR are unknown. We sought to determine predictors of participation and completion of HBCR at the San Francisco VA (SFVA). We evaluated patients hospitalized for ischemic heart disease between 2013 and 2016 at SFVA. Logistic regression models were used to identify predictors of participation and completion of HBCR. In 724 patients with ischemic heart disease who were eligible for CR between 2013 and 2016, 314 (43%) enrolled in HBCR. Older age was associated with lower odds of participation in HBCR (odds ratio [OR] 0.84; p <0.01). Additionally, patients with coronary artery bypass grafting (CABG) were twice as likely as those with percutaneous coronary intervention to participate in HBCR (OR 2.03; 95% confidence interval 1.40, 2.97). In HBCR participants, 48% (150/314) completed ≥9 sessions. Patients with CABG were twice as likely as those with percutaneous coronary intervention to complete the HBCR program (OR 2.02; 95% confidence interval 1.18, 3.44). There were no differences in participation or completion rates by gender, race, ethnicity, or rurality. Our study showed that the SFVAMC HCBR program achieved a 43% participation rate, well above the VA average of 13%. There were no disparities by gender, race, or rurality in terms of participation and adherence. CABG as the indication for CR was the most significant predictor of participation and completion of HBCR.
传统的基于设施的心脏康复（CR）在美国的利用率极低。退伍军人健康管理局（VA）已经开发了新的基于家庭的心脏康复（HBCR）计划来解决这个问题。然而，选择 HBCR 的患者的特征尚不清楚。我们试图确定旧金山退伍军人事务部（SFVA）参与和完成 HBCR 的预测因素。我们评估了 2013 年至 2016 年期间在 SFVA 住院治疗的缺血性心脏病患者。使用逻辑回归模型确定了参与和完成 HBCR 的预测因素。在 2013 年至 2016 年期间有资格接受 CR 的 724 名缺血性心脏病患者中，有 314 名（43%）参加了 HBCR。年龄较大与参与 HBCR 的可能性较低相关（优势比 [OR] 0.84；p <0.01）。此外，与经皮冠状动脉介入治疗相比，接受冠状动脉旁路移植术（CABG）的患者参与 HBCR 的可能性是其两倍（OR 2.03；95%置信区间 1.40，2.97）。在 HBCR 参与者中，有 48%（150/314）完成了≥9 次治疗。与经皮冠状动脉介入治疗相比，接受 CABG 的患者完成 HBCR 计划的可能性是其两倍（OR 2.02；95%置信区间 1.18，3.44）。在性别、种族、民族或农村地区方面，参与率和完成率没有差异。我们的研究表明，SFVAMC HBCR 计划的参与率达到 43%，远高于 VA 的平均水平 13%。在参与和坚持方面，性别、种族或农村地区没有差异。作为 CR 指征的 CABG 是参与和完成 HBCR 的最重要预测因素。
