Digenio A G, Joughin H M
Milpark Rehabilitation and Wellness Centre, Milpark Hospital.
S Afr Med J. 1997 Jun;87 Suppl 3:C136-44.
To determine whether cardiac rehabilitation services are beneficial to patients and cost-effective.
Several recent publications are reviewed. The first of these, 'Cardiac Rehabilitation. Clinical Practice Guideline No. 17', is itself a review of original published research: 900 scientific reports were examined by a multidisciplinary panel and 334 of these were considered to be of sufficient scientific merit to be used as the references for the guideline. The other publications discussed are: The American Heart Association Consensus Panel Statement, 'Preventing heart attack and death in patients with coronary disease', the American College of Cardiology's recommendations on 'Matching the intensity of risk factor management with the hazard for coronary disease events' and Recommendations of the Task Force of the European Society of Cardiology, the European Atherosclerosis Society and European Society of Hypertension, 'Prevention of coronary heart disease in clinical practice'.
Cardiac rehabilitation brought about substantial benefits in risk factor profiles, including improvement in exercise tolerance, blood lipids, psychosocial well-being, and reduction in cigarette smoking and stress levels. In addition there was well-documented proof of improvement of pathophysiological measures, such as relief of symptoms, less progression and greater regression of disease and a reduction in mortality. As an intervention, cardiac rehabilitation was shown to be as cost-effective as many pharmacological regimens and surgical interventions.
The evidence in support of cardiac rehabilitation is so overwhelming that all patients should be educated about this form of treatment and have the ultimate choice of accepting or rejecting it.
确定心脏康复服务是否对患者有益且具有成本效益。
对近期的几篇出版物进行了综述。其中第一篇《心脏康复。临床实践指南第17号》本身就是对已发表的原始研究的综述：一个多学科小组审查了900篇科学报告，其中334篇被认为具有足够的科学价值，可作为该指南的参考文献。讨论的其他出版物有：美国心脏协会共识小组声明《预防冠心病患者的心脏病发作和死亡》、美国心脏病学会关于《使危险因素管理强度与冠心病事件风险相匹配》的建议以及欧洲心脏病学会、欧洲动脉粥样硬化学会和欧洲高血压学会特别工作组的建议《临床实践中冠心病的预防》。
心脏康复在危险因素方面带来了显著益处，包括运动耐量、血脂、心理社会幸福感的改善，以及吸烟和压力水平的降低。此外，有充分记录证明病理生理指标有所改善，如症状缓解、疾病进展减缓、病情好转以及死亡率降低。作为一种干预措施，心脏康复被证明与许多药物治疗方案和手术干预一样具有成本效益。
支持心脏康复的证据非常确凿，所有患者都应接受关于这种治疗形式的教育，并最终有权选择接受或拒绝它。
