Hag Emma, Bäck Maria, Henriksson Peter, Wallert John, Held Claes, Stomby Andreas, Leosdottir Margret
Department of Internal Medicine, County Hospital Ryhov, Sjukhusgatan, 551 85 Jönköping, Sweden.
Division of Prevention, Department of Health, Medicine and Caring Sciences, Rehabilitation and Community Medicine, Unit of Clinical Medicine, Linköping University, 581 83 Linköping, Sweden.
Eur J Cardiovasc Nurs. 2025 Mar 3;24(2):253-263. doi: 10.1093/eurjcn/zvae147.
Improved dietary habits are important for successful secondary prevention after myocardial infarction (MI), with counselling and support on healthy dietary habits constituting a cornerstone of cardiac rehabilitation (CR). However, there is limited knowledge on how to optimize CR organization to motivate patients to adopt healthy dietary habits. We aimed to explore associations between CR programme structure, processes, and self-reported dietary habits 1 year post-MI.
Organizational data from 73 Swedish CR centres and patient-level data from 5248 CR patients were analysed using orthogonal partial least squares discriminant analysis to identify predictors for healthy dietary habits. Variables of importance for the projection (VIP) values exceeding 0.80 were considered meaningful. Key predictors included the CR centre having a medical director [VIP (95% confidence interval)] [1.86 (1.1-2.62)], high self-reported team spirit [1.63 (1.29-1.97)], nurses have formal training in counselling methods [1.20 (0.75-1.65)], providing discharge information on risk factors [2.23 (1.82-2.64)] and lifestyle [1.81 (1.31-2.31)], time dedicated to patient interaction during follow-up [1.60 (0.80-2.40)], and centres aiming for patients to have the same nurse throughout follow-up [1.54 (1.17-1.91)]. The more positive predictors a CR centre reported to follow, the further improvement in patient-level dietary habits, were analysed by multivariable regression analysis [odds ratio for each additional positive predictor reported 1.03 (1.02-1.05), P < 0.001].
Several variables related to CR structure and processes were identified as predictors for patients reporting healthier dietary habits. These findings offer guidance for CR centres in resource allocation and optimizing patient benefits of CR attendance.
改善饮食习惯对心肌梗死（MI）后成功进行二级预防很重要，关于健康饮食习惯的咨询和支持是心脏康复（CR）的基石。然而，关于如何优化CR组织以激励患者养成健康饮食习惯的知识有限。我们旨在探讨CR计划结构、流程与MI后1年自我报告的饮食习惯之间的关联。
使用正交偏最小二乘判别分析对来自73个瑞典CR中心的组织数据和5248名CR患者的患者层面数据进行分析，以确定健康饮食习惯的预测因素。投影重要性变量（VIP）值超过0.80被认为是有意义的。关键预测因素包括CR中心有医学主任[VIP（95%置信区间）][1.86（1.1 - 2.62）]、自我报告的团队精神高[1.63（1.29 - 1.97）]、护士接受过咨询方法的正规培训[1.20（0.75 - 1.65）]、提供关于危险因素的出院信息[2.23（1.82 - 2.64）]和生活方式[1.81（1.31 - 2.31）]、随访期间用于患者互动的时间[1.60（0.80 - 2.40）]以及中心旨在让患者在整个随访期间由同一名护士护理[（1.54（1.17 - 1.91）]。通过多变量回归分析[报告的每增加一个阳性预测因素的优势比为1.03（1.02 - 1.05），P < 0.001]分析发现，CR中心报告遵循的阳性预测因素越多，患者层面的饮食习惯改善就越大。
与CR结构和流程相关的几个变量被确定为患者报告更健康饮食习惯的预测因素。这些发现为CR中心在资源分配和优化患者参加CR的益处方面提供了指导。
