心脏康复对提高急性冠状动脉综合征后依从性及改善临床结局的有效性：一项随机对照试验

Effectiveness of Cardiac Rehabilitation in Enhancing Adherence and Improving Clinical Outcomes Post-Acute Coronary Syndrome: A Randomized Controlled Trial.

作者信息

Tüner Haşim, Polat Fuat, Alıç Enes, Kaya Ali Nail, Çakmak Çiğdem Bahar, Coşkun Ferhat, Özbek Emrah

机构信息

Department of Cardiology, Istanbul Arel University Memorial Bahcelievler Hospital, İstanbul, Türkiye.

Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye.

出版信息

Clin Cardiol. 2025 Jun;48(6):e70160. doi: 10.1002/clc.70160.

DOI:10.1002/clc.70160

PMID:40454770

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12128146/

Abstract

BACKGROUND

Acute coronary syndrome (ACS) remains a major contributor to cardiovascular morbidity and mortality. Cardiac rehabilitation programs have shown promise in improving adherence to lifestyle and medical recommendations, yet their impact on clinical outcomes and complications requires further investigation.

METHODS

This prospective, randomized, single-center study evaluated the effects of cardiac rehabilitation on adherence and clinical outcomes in ACS patients. A total of 340 patients were randomized into a Cardiac Rehabilitation Group or Control Group. The Cardiac Rehabilitation Group underwent supervised exercise, dietary counseling, and education, while the Control Group received standard recommendations. Outcomes, including adherence rates and complications, were assessed over 1 year, with additional interim analyses to evaluate early sustainability of behavioral changes.

RESULTS

Patients in the Cardiac Rehabilitation Group demonstrated significant improvements in adherence to dietary recommendations (73.5% vs. 52.4%, p < 0.01) and physical activity (85.3% vs. 68.2%, p < 0.01). Cardiac Rehabilitation Group patients also experienced fewer instances of weight gain (22.9% vs. 34.7%, p = 0.017) and access site complications (21.2% vs. 40%, p < 0.01). Hospital readmissions were reduced in the Cardiac Rehabilitation Group compared to the Control Group (18.8% vs. 31.2%, p = 0.015). Non-adherence to dietary recommendations (HR: 2.42, 95% CI: 1.08-5.41, p = 0.032) and medical treatments (HR: 2.84, 95% CI: 1.32-6.11, p = 0.007) were significantly associated with increased risk of revascularization.

CONCLUSION

Cardiac rehabilitation significantly enhances adherence to medical and lifestyle recommendations, reduces complications, and improves outcomes in ACS patients. These findings emphasize the critical role of structured rehabilitation in post-ACS management.

摘要

背景

急性冠状动脉综合征（ACS）仍然是心血管疾病发病率和死亡率的主要原因。心脏康复计划在提高对生活方式和医疗建议的依从性方面显示出前景，但其对临床结局和并发症的影响仍需进一步研究。

方法

这项前瞻性、随机、单中心研究评估了心脏康复对ACS患者依从性和临床结局的影响。总共340名患者被随机分为心脏康复组或对照组。心脏康复组接受监督下的运动、饮食咨询和教育，而对照组接受标准建议。在1年的时间里评估包括依从率和并发症在内的结局，并进行额外的中期分析以评估行为改变的早期可持续性。

结果

心脏康复组患者在饮食建议依从性（73.5%对52.4%，p<0.01）和身体活动（85.3%对68.2%，p<0.01）方面有显著改善。心脏康复组患者体重增加（22.9%对34.7%，p=0.017）和穿刺部位并发症（21.2%对40%，p<0.01）的情况也较少。与对照组相比，心脏康复组的医院再入院率降低（18.8%对31.2%，p=0.015）。不遵守饮食建议（HR：2.42，95%CI：1.08-5.41，p=0.032）和药物治疗（HR：2.84，95%CI：1.32-6.11，p=0.007）与血运重建风险增加显著相关。