远程心脏康复在 COVID-19 期间：一项关于健康相关生活质量结局和患者体验的前瞻性队列比较研究。
Remote-delivered cardiac rehabilitation during COVID-19: a prospective cohort comparison of health-related quality of life outcomes and patient experiences.
机构信息
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, D18 Western Avenue, Camperdown, NSW 2006, Australia.
Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2006, Australia.
出版信息
Eur J Cardiovasc Nurs. 2022 Oct 14;21(7):732-740. doi: 10.1093/eurjcn/zvac006.
AIMS
Enforced suspension and reduction of in-person cardiac rehabilitation (CR) services during the coronavirus disease-19 (COVID-19) pandemic restrictions required rapid implementation of remote delivery methods, thus enabling a cohort comparison of in-person vs. remote-delivered CR participants. This study aimed to examine the health-related quality of life (HRQL) outcomes and patient experiences comparing these delivery modes.
METHODS AND RESULTS
Participants across four metropolitan CR sites receiving in-person (December 2019 to March 2020) or remote-delivered (April to October 2020) programmes were assessed for HRQL (Short Form-12) at CR entry and completion. A General Linear Model was used to adjust for baseline group differences and qualitative interviews to explore patient experiences. Participants (n = 194) had a mean age of 65.94 (SD 10.45) years, 80.9% males. Diagnoses included elective percutaneous coronary intervention (40.2%), myocardial infarction (33.5%), and coronary artery bypass grafting (26.3%). Remote-delivered CR wait times were shorter than in-person [median 14 (interquartile range, IQR 10-21) vs. 25 (IQR 16-38) days, P < 0.001], but participation by ethnic minorities was lower (13.6% vs. 35.2%, P < 0.001). Remote-delivered CR participants had equivalent benefits to in-person in all HRQL domains but more improvements than in-person in Mental Health, both domain [mean difference (MD) 3.56, 95% confidence interval (CI) 1.28, 5.82] and composite (MD 2.37, 95% CI 0.15, 4.58). From qualitative interviews (n = 16), patients valued in-person CR for direct exercise supervision and group interactions, and remote-delivered for convenience and flexibility (negotiable contact times).
CONCLUSION
Remote-delivered CR implemented during COVID-19 had equivalent, sometimes better, HRQL outcomes than in-person, and shorter wait times. Participation by minority groups in remote-delivered modes are lower. Further research is needed to evaluate other patient outcomes.
目的
在 2019 冠状病毒病（COVID-19）大流行限制期间，强制性暂停和减少心脏康复（CR）服务，这需要迅速实施远程交付方法，从而能够对面对面和远程交付的 CR 参与者进行队列比较。本研究旨在比较这些交付模式，以检查与健康相关的生活质量（HRQL）结果和患者体验。
方法和结果
在四个大都市 CR 地点接受面对面（2019 年 12 月至 2020 年 3 月）或远程交付（2020 年 4 月至 10 月）方案的参与者在 CR 入组和完成时接受 HRQL（简短形式 12）评估。使用一般线性模型来调整基线组间差异，并进行定性访谈以探讨患者体验。参与者（n=194）的平均年龄为 65.94（SD 10.45）岁，80.9%为男性。诊断包括选择性经皮冠状动脉介入治疗（40.2%）、心肌梗死（33.5%）和冠状动脉旁路移植术（26.3%）。远程交付的 CR 等待时间短于面对面交付[中位数 14（四分位距，IQR 10-21）与 25（IQR 16-38）天，P < 0.001]，但少数民族的参与率较低（13.6%与 35.2%，P < 0.001）。远程交付的 CR 在所有 HRQL 领域的参与者都与面对面交付的参与者具有同等获益，但在心理健康方面的获益优于面对面交付，包括两个领域[平均差异（MD）3.56，95%置信区间（CI）1.28，5.82]和综合领域[MD 2.37，95%CI 0.15，4.58]。从定性访谈（n=16）中，患者对面对面 CR 的直接运动监督和小组互动，以及远程 CR 的便利性和灵活性（可协商的联系时间）都给予了高度评价。
结论
在 COVID-19 期间实施的远程交付的 CR 具有与面对面交付同等甚至更好的 HRQL 结果，且等待时间更短。少数民族参与远程交付模式的比例较低。需要进一步研究以评估其他患者结果。
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