心脏康复对冠心病患者健康相关生活质量的影响：荟萃分析。

The Effect of Cardiac Rehabilitation on Health-Related Quality of Life in Patients With Coronary Artery Disease: A Meta-analysis.

机构信息

Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.

出版信息

Can J Cardiol. 2019 Mar;35(3):352-364. doi: 10.1016/j.cjca.2018.11.013. Epub 2018 Nov 24.

DOI:10.1016/j.cjca.2018.11.013

PMID:30825955

Abstract

BACKGROUND

The clinical effectiveness of cardiac rehabilitation (CR) on health-related quality of life (HRQOL) is an area that has not been consistently explored. The objective of this systematic review was to evaluate the effectiveness of providing any core component of CR on HRQOL domains.

METHODS

We performed a meta-analysis and meta-regression of randomized controlled trials (RCTs) on the core components of CR. RCTs included adult patients with diagnosed coronary artery disease via angiography, myocardial infarction, angina, or who had undergone coronary revascularization. The Cochrane Library, MEDLINE, EMBASE, CINAHL, SCI-EXPANDED, Psych INFO, and Web of Science were searched from inception to April 27, 2017. Outcomes included overall, physical, emotional, and social HRQOL. Outcomes were reported as standardized mean change (SMC) with 95% confidence intervals (CIs). Effect size changes of 0.2, 0.5, and 0.8 SD units reflect a small, moderate, and large effect, respectively.

RESULTS

Forty-nine reports of 41 RCTs with 11,747 patients were included. Summary effect sizes were: overall HRQOL SMC, 0.28 (95% CI, 0.05-0.50), physical HRQOL SMC, 0.47 (95% CI, 0.13-0.81), emotional HRQOL SMC, 0.37 (95% CI, -0.02 to 0.77), and social HRQOL SMC, 0.13 (95% CI, -0.06 to 0.32). Meta-regression revealed type of CR intervention and year of publication as positive statistically significant treatment effect modifiers.

CONCLUSIONS

Receiving CR was shown to improve HRQOL, with exercise-, nonexercise-, and psychological-based interventions playing a vital role. Although these improvements in HRQOL were modest they still reflect an incremental benefit compared with receiving usual care.

摘要

背景

心脏康复（CR）对健康相关生活质量（HRQOL）的临床疗效是一个尚未得到一致探索的领域。本系统评价的目的是评估提供 CR 的任何核心组成部分对 HRQOL 领域的有效性。

方法

我们对 CR 的核心组成部分进行了荟萃分析和荟萃回归分析。RCT 纳入了通过血管造影诊断为冠心病、心肌梗死、心绞痛或接受过冠状动脉血运重建的成年患者。我们从建库开始至 2017 年 4 月 27 日，在 Cochrane 图书馆、MEDLINE、EMBASE、CINAHL、SCI-EXPANDED、PsychINFO 和 Web of Science 上进行了检索。结果包括总体、身体、情感和社会 HRQOL。结果以标准化均数差值（SMC）和 95%置信区间（CI）报告。0.2、0.5 和 0.8 个标准差的效应大小变化分别反映了小、中和大的效应。

结果

纳入了 41 项 RCT 的 49 份报告，共 11747 名患者。综合效应大小为：总体 HRQOL SMC，0.28（95%CI，0.05-0.50）；身体 HRQOL SMC，0.47（95%CI，0.13-0.81）；情感 HRQOL SMC，0.37（95%CI，-0.02 至 0.77）；社会 HRQOL SMC，0.13（95%CI，-0.06 至 0.32）。荟萃回归显示 CR 干预类型和发表年份是具有统计学意义的治疗效果修饰因子。