Faculty of Health, York University, Canada.
Vermont Center on Behavior and Health, University of Vermont, USA.
Eur J Prev Cardiol. 2020 Jun;27(9):912-928. doi: 10.1177/2047487319878958. Epub 2019 Oct 4.
Cardiac rehabilitation is a comprehensive model of secondary prevention proven to reduce mortality and morbidity. The World Health Organization is developing a Package of Rehabilitation Interventions for implementation by ministries of health as part of universal healthcare across the continuum. Through a systematic review, we sought to identify the best-quality cardiac rehabilitation guidelines, and extract their recommendations for implementation by member states. A systematic search was undertaken of academic databases and guideline repositories, among other sources, through to April 2019, for English-language cardiac rehabilitation guidelines from the last 10 years, free from conflicts, and with strength of recommendations. Two authors independently considered all citations. Potentially eligible guidelines were rated for quality using the Appraisal of Guidelines for Research and Evaluation tool, and for other characteristics such as being multi-professional, comprehensive and international in perspective; the latter criteria were used to inform selection of 3-5 guidelines meeting inclusion criteria. Equity considerations were also extracted. Altogether, 2076 unique citations were identified. Thirteen passed title and abstract screening, with six guidelines potentially eligible for inclusion in the Package of Rehabilitation Interventions and rated for quality; for two guidelines the Appraisal of Guidelines for Research and Evaluation tool ratings did not meet World Health Organization minimums. Of the four eligible guidelines, three were selected: the International Council of Cardiovascular Prevention and Rehabilitation (2016), National Institute for Health and Care Excellence (#172; 2013) and Scottish Intercollegiate Guideline Network (#150; 2017). Extracted recommendations were comprehensive, but psychosocial recommendations were contradictory and diet recommendations were inconsistent. A development group of the World Health Organization will review and refine the recommendations which will then undergo peer review, before open source dissemination for implementation.
心脏康复是一种被证实可降低死亡率和发病率的二级预防综合模式。世界卫生组织正在制定一套康复干预措施包，供各国卫生部作为普及全民医疗保健的一部分加以实施。通过系统评价，我们试图确定质量最佳的心脏康复指南，并从中提取会员国实施的建议。我们对学术数据库和指南库等其他来源进行了系统搜索，截至 2019 年 4 月，检索了过去 10 年中没有利益冲突且具有推荐强度的英文心脏康复指南。两位作者独立考虑了所有引用文献。使用评估研究和评估工具（AGREE）对潜在的合格指南进行质量评估，并评估其他特征，如多专业、全面和具有国际视角；后者标准用于确定符合纳入标准的 3-5 条指南。还提取了公平性考虑因素。总共确定了 2076 条独特的引文。13 条通过标题和摘要筛选，有 6 条指南可能有资格纳入康复干预措施包，并进行了质量评估；对于两条指南，评估研究和评估工具的 AGREE 评分不符合世界卫生组织的最低要求。在符合条件的四条指南中，选择了三条：国际心血管预防和康复理事会（2016 年）、英国国家卫生与保健优化研究所（2013 年）和苏格兰校际指南网（2017 年）。提取的建议是全面的，但心理社会建议存在矛盾，饮食建议不一致。世界卫生组织的一个发展小组将审查和完善这些建议，然后进行同行评审，最后开源发布供实施。
