Department of Medical Informatics, Amsterdam UMC, Location AMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands.
Department of Cardiology, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Eur J Prev Cardiol. 2021 May 14;28(5):572-580. doi: 10.1093/eurjpc/zwaa066.
Recent studies showed that exercise-based cardiac rehabilitation (ECR) programmes are often not personalized to individual patient characteristics according to latest recommendations. This study investigates whether a computerized decision support (CDS) system based on latest recommendations and guidelines can improve personalization of ECR prescriptions. Pseudo-randomized intervention study.
Among participating Dutch cardiac rehabilitation centres, ECR programme characteristics of consecutive patients were recorded during 1 year. CDS was used during a randomly assigned 4-month period within this year. Primary outcome was concordance to latest recommendations in three phases (before, during, and after CDS) for 12 ECR programme characteristics. Secondary outcome was variation in training characteristics. We recruited ten Dutch CR centres and enrolled 2258 patients to the study. Overall concordance of ECR prescriptions was 59.9% in Phase 1, 62.1% in Phase 2 (P = 0.82), and 59.9% in Phase 3 (P = 0.56). Concordance varied from 0.0% to 99.9% for the 12 ECR characteristics. There was significant between-centre variation for most training characteristics in Phases 1 and 2. In Phase 3, there was only a significant variation for aerobic and resistance training intensity (P = 0.01), aerobic training volume (P < 0.01), and the number of strengthening exercises but no longer for the other characteristics. Aerobic training volume was often below recommended (28.2%) and declined during the study.
CDS did not substantially improve concordance with ECR prescriptions. As aerobic training volume was often lower than recommended and reduced during the study, a lack of institutional resources might be an important barrier in personalizing ECR prescriptions.
最近的研究表明，根据最新建议，基于运动的心脏康复（ECR）计划通常不能针对个体患者的特点进行个性化定制。本研究旨在调查基于最新建议和指南的计算机决策支持（CDS）系统是否可以提高 ECR 处方的个性化程度。这是一项伪随机干预研究。
在参与的荷兰心脏康复中心中，连续患者的 ECR 计划特征在一年内被记录下来。在这一年中的随机分配的 4 个月期间使用 CDS。主要结果是在三个阶段（CDS 之前、期间和之后）中，根据最新建议，12 个 ECR 计划特征的一致性。次要结果是训练特征的变化。我们招募了 10 个荷兰心脏康复中心，共有 2258 名患者参与了这项研究。整体 ECR 处方的一致性在第 1 阶段为 59.9%，第 2 阶段为 62.1%（P=0.82），第 3 阶段为 59.9%（P=0.56）。12 个 ECR 特征的一致性从 0.0%到 99.9%不等。在第 1 阶段和第 2 阶段，大多数训练特征的中心之间存在显著差异。在第 3 阶段，只有有氧运动和阻力训练强度（P=0.01）、有氧运动训练量（P<0.01）和强化训练次数有显著差异，但其他特征则没有。有氧运动训练量往往低于推荐量（28.2%），且在研究期间有所下降。
CDS 并未显著提高 ECR 处方的一致性。由于有氧运动训练量往往低于推荐量且在研究期间减少，机构资源的缺乏可能是个性化 ECR 处方的一个重要障碍。
