冠心病患者的心脏康复——提供、参与情况及结果：来自世界卫生组织六个区域14个国家的INTERASPIRE调查结果
Cardiac Rehabilitation in Patients with Coronary Heart Disease - Provision, Attendance, and Outcomes: Results from the INTERASPIRE Survey from Fourteen Countries Across Six WHO Regions.
作者信息
Kotseva Kornelia, De Bacquer Dirk, Jennings Catriona, McEvoy John William, Ryden Lars, Ray Kausik K, Lip Gregory Y H, Erlund Iris, Ganly Sandra, Vihervaara Terhi, Adamska Agnieszka, Abreu Ana, Almahmeed Wael, Ambari Ade Meidian, Connolly Susan, Ge Junbo, Gibson Irene, Hasan-Ali Hosam, Hennessy Sue, Huo Yong, Jankowski Piotr, Jimenez Rodney M, Jones Jennifer, Li Yong, Zuhdi Ahmad Syadi Mahmood, Makubi Abel, Mbakwem Amam Chinyere, Mbau Lilian, Estrada Jose Luis Navarro, Ogah Okechukwu Samuel, Ogola Elijah Nyainda, Quintero-Baiz Adalberto, Sani Mahmoud Umar, Liprandi Maria Ines Sosa, Tan Jack Wei Chieh, Thompson David R, Triana Miguel Alberto Urina, Yeo Tee Joo, Wood David, De Backer Guy G
机构信息
University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Galway, Ireland.
Imperial College Healthcare NHS Trust, London, UK.
出版信息
Glob Heart. 2025 Sep 2;20(1):75. doi: 10.5334/gh.1458. eCollection 2025.
BACKGROUND
INTERASPIRE was an observational study of patients with coronary heart disease (CHD) from 88 hospitals in 14 countries across all six WHO regions. The objective was to describe the proportions of patients referred to and attending cardiac rehabilitation (CR) programmes and to compare lifestyle and risk factor target achievement according to participation in a CR programme.
METHODS
Patients 18-80 years of age, with a first or recurrent coronary hospitalisation (acute coronary syndrome and/or revascularisation procedure) were identified and invited to an interview and examination, between six months and two years after the index hospitalisation.
RESULTS
Overall, 4,548 (21.1% female) patients were interviewed a median of 1.05 (interquartile range 0.76-1.45) years after hospitalization. Of those patients, 34.4% reported having been advised to participate in a CR programme, though the percentage varied widely by country, from 4.0% in Kenya to 69.6% in Poland. Among patients advised to participate in CR, 57.1% participated in ≥50% of all sessions, 15.4% participated in <50% of the sessions, and 27.4% did not participate at all. Only 19.6% of all patients recruited to the study attended ≥50% of sessions. Content of programmes reported by patients also varied enormously between countries. Low education level, elective PCI, or unstable angina as recruiting events were associated with lower attendance rates. Attendance at ≥50% of all CR sessions was associated with a lower prevalence of persistent smoking and physical inactivity, better control of blood pressure and LDL-cholesterol, and a higher use of cardioprotective medications.
CONCLUSIONS
INTERASPIRE provides a standardised international picture of CR provision and attendance in patients with CHD. Despite CR being a Class 1 recommendation in all international guidelines, only one third of CHD patients reported being advised to attend any form of CR and just one in five patients attended 50% of the sessions, with striking heterogeneity between regions and countries. National cardiology societies should advocate to their governments for urgent investment in standardised CR services.
背景
INTERASPIRE是一项针对来自世界卫生组织六个区域14个国家88家医院的冠心病（CHD）患者的观察性研究。目的是描述被转诊至心脏康复（CR）项目并参加该项目的患者比例，并根据参与CR项目的情况比较生活方式和危险因素目标的达成情况。
方法
确定年龄在18 - 80岁、首次或再次因冠心病住院（急性冠脉综合征和/或血运重建手术）的患者，并在索引住院后6个月至2年邀请他们接受访谈和检查。
结果
总体而言，4548名患者（21.1%为女性）在住院中位数1.05年（四分位间距0.76 - 1.45年）后接受了访谈。在这些患者中，34.4%报告曾被建议参加CR项目，不过各国的这一比例差异很大，从肯尼亚的4.0%到波兰的69.6%。在被建议参加CR的患者中，57.1%参加了所有疗程的≥50%，15.4%参加了<50%的疗程，27.4%根本没有参加。在纳入该研究的所有患者中，只有19.6%参加了≥50%的疗程。各国患者报告的项目内容也有很大差异。低教育水平、择期经皮冠状动脉介入治疗（PCI）或因不稳定型心绞痛作为入选事件与较低的参与率相关。参加所有CR疗程的≥50%与持续吸烟和身体活动不足的患病率较低、血压和低密度脂蛋白胆固醇控制较好以及心脏保护药物使用较多有关。
结论
INTERASPIRE提供了冠心病患者CR服务提供和参与情况的标准化国际图景。尽管CR在所有国际指南中均为I类推荐，但只有三分之一的冠心病患者报告曾被建议参加任何形式的CR，且只有五分之一的患者参加了50%的疗程，各地区和国家之间存在显著差异。各国心脏病学会应向其政府倡导紧急投资于标准化的CR服务。
Zotero 插件