Orzechowski Piotr, Kowalik Ilona, Piotrowicz Ewa
Telecardiology Center, National Institute of Cardiology, Warsaw, Poland.
Clinical Research Support Center, National Institute of Cardiology, Warsaw, Poland
Pol Arch Intern Med. 2023 Sep 29;133(9). doi: 10.20452/pamw.16456. Epub 2023 Mar 6.
Managed Care after Myocardial Infarction (MC‑AMI [KOS-Zawał]), a comprehensive care program dedicated to patients after myocardial infarction, was implemented in Poland in 2017. Hybrid cardiac telerehabilitation (HTR) is a unique component of MC‑AMI.
We evaluated the feasibility of HTR as a component of MC‑AMI and assessed its safety and acceptance by patients. One‑year all‑cause mortality among the patients participating and not participating in MC‑AMI was analyzed.
The MC‑AMI group included 114 patients who underwent a 5‑week HTR program comprising telemonitored Nordic walking training sessions, and who completed the entire 12‑month MC‑AMI program. The influence of HTR on the physical capacity was assessed by comparing the stress test results before and after HTR. After HTR, the patients completed a satisfaction survey to assess their acceptance of the program. The non-MC‑AMI group was formed using propensity score matching to compare 1‑year all‑cause mortality between the patients participating and not participating in MC-AMI.
HTR significantly improved the functional capacity assessed in the stress test and was well‑received by the patients. In the study group, nonfatal non-ST‑segment elevation myocardial infarction, elective coronary percutaneous intervention, and cardiovascular hospitalization occurred in 0.9%, 2.6% and 6.1% of the patients, respectively. There were no deaths among the MC‑AMI participants, whereas in the non-MC‑AMI group, 1‑year all‑cause mortality was 3.5%. The log‑rank test comparing the survival probabilities of matched groups, estimated by the Kaplan-Meier method, showed heterogeneity of the curves (P = 0.04).
HTR as a component of MC‑AMI was a feasible, safe, and well‑accepted form of cardiac rehabilitation. Participation in MC‑AMI including HTR was associated with a significantly lower risk of 1‑year all‑cause mortality, as compared with not taking part in the rehabilitation program.
心肌梗死后管理式照护（MC-AMI [KOS-Zawał]）是一项针对心肌梗死后患者的综合照护计划，于2017年在波兰实施。混合心脏远程康复（HTR）是MC-AMI的一个独特组成部分。
我们评估了HTR作为MC-AMI组成部分的可行性，并评估了其安全性及患者的接受度。分析了参与和未参与MC-AMI的患者的一年全因死亡率。
MC-AMI组包括114例患者，他们接受了为期5周的HTR计划，该计划包括远程监测的北欧式健走训练课程，并完成了整个12个月的MC-AMI计划。通过比较HTR前后的压力测试结果来评估HTR对身体能力的影响。HTR后，患者完成了一项满意度调查，以评估他们对该计划的接受度。非MC-AMI组采用倾向得分匹配法形成，以比较参与和未参与MC-AMI的患者之间的一年全因死亡率。
HTR显著改善了压力测试中评估的功能能力，且受到患者的好评。在研究组中，非致命性非ST段抬高型心肌梗死、择期冠状动脉经皮介入治疗和心血管住院分别发生在0.9%、2.6%和6.1%的患者中。MC-AMI参与者中无死亡病例，而非MC-AMI组的一年全因死亡率为3.5%。通过Kaplan-Meier方法估计的比较匹配组生存概率的对数秩检验显示曲线存在异质性（P = 0.04）。
HTR作为MC-AMI的一个组成部分，是一种可行、安全且广受接受的心脏康复形式。与未参加康复计划相比，参与包括HTR的MC-AMI与一年全因死亡率显著降低相关。
