心梗后心脏康复中达到关键风险因素目标的组织和患者水平预测因素：完美-CR 研究。

Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction: The Perfect-CR study.

机构信息

Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.

Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.

出版信息

Int J Cardiol. 2023 Jan 15;371:40-48. doi: 10.1016/j.ijcard.2022.09.012. Epub 2022 Sep 9.

DOI:10.1016/j.ijcard.2022.09.012

PMID:36089158

Abstract

BACKGROUND

Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI.

METHODS

In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8 mmol/L, blood pressure (BP) <140/90 mmHg and smoking abstinence.

RESULTS

The strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78-2.50]; 2.45 [1.91-2.99]), having a psychologist in the CR team (1.62 [1.36-1.87]; 2.05 [1.67-2.44]), extended opening hours (2.13 [2.00-2.27]; 1.50 [0.91-2.10]), adequate facilities (1.54 [0.91-2.18]; 1.89 [1.38-2.40]), and having a medical director (1.70 [0.91-2.48]; 1.46 [1.04-1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39-4.51]) and having no history of hypertension (2.93 [2.60-3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66-2.10]; 1.46 [1.14-1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95-2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07-2.88]) and group education (1.92 [1.43-2-42]), and no cardiovascular disease history (2.13 [1.78-2.48]).

CONCLUSIONS

We identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.

摘要

背景

心脏康复（CR）项目对心肌梗死后实现风险因素目标的益处以及相对于患者特征的预测强度仍不清楚。我们旨在确定一年后 MI 患者实现风险因素目标的组织和患者水平预测因素。

方法

在这项观察性研究中，收集了 78 家瑞典 CR 中心的 CR 组织数据，并与患者水平的登记数据（n=7549）合并。正交偏最小二乘判别分析确定了实现低密度脂蛋白胆固醇（LDL-C）<1.8mmol/L、血压（BP）<140/90mmHg 和戒烟目标的预测因素（变量重要性投影值（VIP）>0.8）。

结果

实现 LDL-C 和 BP 目标的最强预测因素（VIP[95%CI]）是提供心理社会管理（2.14[1.78-2.50]；2.45[1.91-2.99]）、CR 团队中有心理学家（1.62[1.36-1.87]；2.05[1.67-2.44]）、延长开放时间（2.13[2.00-2.27]；1.50[0.91-2.10]）、设施充足（1.54[0.91-2.18]；1.89[1.38-2.40]）和有医疗主任（1.70[0.91-2.48]；1.46[1.04-1.88]）。实现 LDL-C 和/或 BP 目标的最强患者水平预测因素分别是低基线 LDL-C（3.95[3.39-4.51]）和无高血压史（2.93[2.60-3.26]），其次是基于运动的 CR 参与（1.38[0.66-2.10]；1.46[1.14-1.78]）。对于戒烟，组织上最强的预测因素是 CR 医生开具的伐尼克兰（1.88[0.95-2.80]），而患者水平的预测因素是参加基于运动的 CR（2.47[2.07-2.88]）和小组教育（1.92[1.43-2.42]），以及无心血管疾病史（2.13[1.78-2.48]）。