Grace Sherry L, Prior Peter L, Mamataz Taslima, Hartley Tim, Oh Paul, Suskin Neville
York University, Toronto, Ontario, Canada (Drs Grace and Mamataz); KITE, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Grace and Oh); Lawson Health Research Institute, St Joseph's Health Care, London, Ontario, Canada (Drs Prior and Suskin and Mr Hartley); and Department of Medicine, Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada (Mr Suskin).
J Cardiopulm Rehabil Prev. 2021 Jan 1;41(1):40-45. doi: 10.1097/HCR.0000000000000571.
To examine: (1) the rate of clinical events precluding cardiac rehabilitation (CR) continuation, (2) CR attendance by component in those without events, and (3) the association between disease severity (eg, tobacco use, diabetes, and depression) and component attendance (eg, exercise, diet, stress management, and tobacco cessation).
Retrospective analysis of electronic records of the CR program in London, Ontario, from 1999 to 2017. Patients in the supervised program are offered exercise sessions 2 times/wk with a minimum of 48 prescribed sessions tailored to patient need. Patients attending ≥1 session without major factors that would limit their exercise ability were included. Intervening events were recorded, as was component attendance.
Of 5508 enrolled, supervised patients, 3696 did not have a condition that could preclude exercise. Of those enrolled, one-sixth (n = 912) had an intervening event; these patients were less likely to work, more likely to have medical risk factors, had more severe angina and depression, and lower functional capacity. The remaining cohort attended a mean of 26.5 ± 21.3 sessions overall (median = 27; 19% attending ≥48 sessions), including 20.5 ± 17.4 exercise sessions (median = 21). After exercise, the most common components attended were individual dietary and psychological counseling. Patients with more severe angina and depressive symptoms as well as tobacco users attended significantly fewer total sessions, but more of some specific components.
In one-sixth of patients, CR attendance and completion are impacted by clinical factors beyond their control. Many patients are taking advantage of components specific to their risk factors, buttressing the value of individually tailored, menu-based programming.
研究：（1）导致心脏康复（CR）无法继续进行的临床事件发生率；（2）未发生此类事件的患者参与CR各组成部分的情况；（3）疾病严重程度（如吸烟、糖尿病和抑郁症）与各组成部分参与情况（如运动、饮食、压力管理和戒烟）之间的关联。
对安大略省伦敦市1999年至2017年CR项目的电子记录进行回顾性分析。在监督项目中的患者每周接受2次锻炼课程，根据患者需求至少安排48次规定课程。纳入参加了≥1次课程且无会限制其运动能力的主要因素的患者。记录干预事件以及各组成部分的参与情况。
在5508名登记并接受监督的患者中，3696人没有会妨碍运动的疾病。在这些登记患者中，六分之一（n = 912）发生了干预事件；这些患者工作的可能性较小，更有可能有医学风险因素，心绞痛和抑郁症更严重，功能能力更低。其余队列总体上平均参加了26.5±21.3次课程（中位数 = 27；19%的人参加了≥48次课程），包括20.5±17.4次运动课程（中位数 = 21）。运动之后，最常参与的组成部分是个体饮食和心理咨询。心绞痛和抑郁症状更严重的患者以及吸烟者参加的总课程明显较少，但某些特定组成部分的参与度更高。
六分之一的患者中，CR的参与和完成受到他们无法控制的临床因素的影响。许多患者正在利用针对其风险因素的特定组成部分，这支持了基于菜单的个性化编程的价值。
