侯欣宇,李奇峰,李桂华,马梅,郑祥慧,王时宇,吴孝军,曹天辉,王卓众,吴健,于波

• 1:哈尔滨医科大学附属第二医院心内科
• 2:大连医科大学附属第二医院
• 3:天津胸科医院

摘要(Abstract)：

目的 探讨急性心肌梗死（AMI）患者心脏康复（CR）依从性的影响因素。方法 纳入2018年1月15日至2019年9月17日来自国内42家医院共3 812例AMI后有意愿参与CR的患者，收集患者临床基线资料，根据患者出院后第3、12个月的CR随访情况进行依从性分组，比较两组患者的群体特征，通过Logistic回归分析得出影响AMI患者CR依从性的因素。结果 3 812例患者其中依从组2 090例（54.8%），不依从组1 722例（45.2%）。多因素Logistic回归分析显示文化程度（小学：OR 0.458, 95%CI 0.359～0.584；初中：OR 0.593,95%CI 0.474～0.741；高中及中专：OR 0.775,95%CI 0.612～0.980、居住地（城镇：OR 1.250,95%CI 1.058～1.477）、吸烟史（OR 1.349,95%CI 1.166～1.561）、血脂异常（OR 1.300,95%CI1.135～1.488）、冠心病家族史（OR 2.717,95%CI 1.842～4.007）、经皮冠状动脉介入治疗（PCI）手术史（OR 0.615, 95%CI 0.457～0.827）、脑卒中病史（OR 0.755, 95%CI 0.614～0.928）以及血运重建方式[冠状动脉支架置入术（CS）:OR 2.184, 95%CI 1.671～2.855]为其独立影响因素（均P <0.05）。结论 研究中近半数的患者存在依从性欠佳的问题。大专及本科以上文化程度、居于城镇、存在吸烟史、合并血脂异常、合并冠心病家族史、无既往行PCI史、无脑卒中史以及接受CS治疗的AMI患者CR依从性相对不存在上述特点的AMI患者更佳。

关键词(KeyWords)： 急性心肌梗死;心脏康复;依从性;影响因素分析

Abstract:

Keywords:

基金项目(Foundation): “重大慢性非传染性疾病防控研究”重点专项项目（2016YFC1301105）

作者(Author): 侯欣宇,李奇峰,李桂华,马梅,郑祥慧,王时宇,吴孝军,曹天辉,王卓众,吴健,于波

参考文献(References)：

• [1]Ibanez B,James S,Agewall S,et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2018,39(2):119-177.DOI:10.1093/eurheartj/ehx393.
• [2]Bohplian S,Bronas UG.Motivational strategies and concepts to increase participation and adherence in cardiac rehabilitation:an integrative review[J].J Cardiopulm Rehabil Prev,2022,42(2):75-83.DOI:10.1097/HCR.0000000000000639.
• [3]Pedersen CG,Nielsen CV,Lynggaard V,et al.The patient education strategy“learning and coping”improves adherence to cardiac rehabilitation in primary healthcare settings:a pragmatic cluster-controlled trial[J].BMC Cardiovasc Disord,2022,22(1):364.DOI:10.1186/s12872-022-02774-8.
• [4]Barrett S,Begg S,O’Halloran P,et al.Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults:a systematic review and Meta-analyses[J].BMC Public Health,2018,18(1):1160.DOI:10.1186/s12889-018-6062-9.
• [5]Hald K,Larsen FB,Nielsen KM,et al.Medication adherence,biological and lifestyle risk factors in patients with myocardial infarction:a ten-year follow-up on socially differentiated cardiac rehabilitation[J].Scand J Prim Health Care,2019,37(2):182-190.DOI:10.1080/02813432.2019.1608046.
• [6]Janssen V,De Gucht V,van Exel H,et al.A self-regulation lifestyle program for post-cardiac rehabilitation patients has longterm effects on exercise adherence[J].J Behav Med,2014,37(2):308-321.DOI:10.1007/s10865-012-9489-y.
• [7]Bakhshayeh S,Sarbaz M,Kimiafar K,et al.Barriers to participation in center-based cardiac rehabilitation programs and patients’attitude toward home-based cardiac rehabilitation programs[J].Physiother Theory Pract,2021,37(1):158-168.DOI:10.1080/09593985.2019.1620388.
• [8]中国康复医学会心血管病预防与康复专业委员会，中国老年学与老年医学学会，心血管病专业委员会.医院主导的家庭心脏康复中国专家共识[J].中华内科杂志，2021,60(3):207-215.DOI:10.3760/cma.j.cn112138-20200629-00630.
• [9]中国医师协会心血管内科医师分会，中国医院协会心脏康复管理专业委员会.慢性冠状动脉综合征患者运动康复分级诊疗中国专家共识[J].中国介入心脏病学杂志，2021,29(7):361-370.DOI:10.3969/j.issn.1004-8812.2021.07.001.
• [10]Azzani M,Roslani AC,Su TT.Financial burden of colorectal cancer treatment among patients and their families in a middleincome country[J].Support Care Cancer,2016,24(10):4423-4432.DOI:10.1007/s00520-016-3283-2.
• [11]M a d d i s o n R,R a w s t o r n J C,S t e w a r t R A H,e t a l.Effects and costs of real-time cardiac telerehabilitation:randomised controlled non-inferiority trial[J].Heart,2019,105(2):122-129.DOI:10.1136/heartjnl-2018-313189.
• [12]Dunlay SM,Witt BJ,Allison TG,et al.Barriers to participation in cardiac rehabilitation[J].Am Heart J,2009,158(5):852-859.DOI:10.1016/j.ahj.2009.08.010.
• [13]Nichols S,Nation F,Goodman T,et al.CARE CR-cardiovascular and cardiorespiratory adaptations to routine exercise-based cardiac rehabilitation:a study protocol for a community-based controlled study with criterion methods[J].BMJ Open,2018,8(1):e019216.DOI:10.1136/bmjopen-2017-019216.
• [14]Yeom H,Lim HS,Min J,et al.Factors affecting smoking cessation success of heavy smokers registered in the intensive care smoking cessation camp (Data from the National Tobacco Control Center)[J].Osong Public Health Res Perspect,2018,9(5):240-247.DOI:10.24171/j.phrp.2018.9.5.05.
• [15]Zorina O,Fatkulina N,Saduyeva F,et al.Patient adherence to therapy after myocardial infarction:a scoping review[J].Patient Prefer Adherence,2022,16:1613-1622.DOI:10.2147/PPA.S356653.
• [16]Keessen P,den Uijl I,Visser B,et al.Fear of movement in patients attending cardiac rehabilitation:a validation study[J].J Rehabil Med,2020,52(2):jrm00021.DOI:10.2340/16501977-2653.
• [17]张大鹏，王乐丰，刘宇，等.药物涂层球囊与药物洗脱支架治疗冠状动脉原发病变的疗效与安全性比较[J].中华心血管病杂志，2020,48 (7):600-607.DOI:10.3760/cma.j.cn112148-20200327-00254.
• [18]Goldstein DW,Hajduk AM,Song X,et al.Factors associated with cardiac rehabilitation participation in older adults after myocardial infarction:the silver-ami study[J].J Cardiopulm Rehabil Prev,2022,42(2):109-114.DOI:10.1097/HCR.0000000000000627.
• [19]Ruano-Ravina A,Pena-Gil C,Abu-Assi E,et al.Participation and adherence to cardiac rehabilitation programs.A systematic review[J].Int J Cardiol,2016,223:436-443.DOI:10.1016/j.ijcard.2016.08.120.
• [20]Wenger NK.Cardiovascular disease in women:understanding the journey[J].Clin Chem,2021,67(1):24-29.DOI:10.1093/clinchem/hvaa297.
• [21]Norris CM,Yip CYY,Nerenberg KA,et al.State of the science in women’s cardiovascular disease:a Canadian perspective on the influence of sex and gender[J].J Am Heart Assoc,2020,9(4):e015634.DOI:10.1161/JAHA.119.015634.
• [22]Colella TJ,Gravely S,Marzolini S,et al.Sex bias in referral of women to outpatient cardiac rehabilitation?A Meta-analysis[J].Eur J Prev Cardiol,2015,22(4):423-441.DOI:10.1177/2047487314520783.
• [23]Wills WB,Athilingam P,Beckie TM.Exercise-based cardiac rehabilitation in women with heart failure:a review of enrollment,adherence,and outcomes[J].Heart Fail Rev,2023.Online ahead of print.DOI:10.1007/s10741-023-10306-5.
• [24]Mamataz T,Ghisi GLM,Pakosh M,et al.Nature,availability,and utilization of women-focused cardiac rehabilitation:a systematic review[J].BMC Cardiovasc Disord,2021,21(1):459.DOI:10.1186/s12872-021-02267-0.
• [25]Grace SL,Midence L,Oh P,et al.Cardiac rehabilitation program adherence and functional capacity among women:a randomized controlled trial[J].Mayo Clin Proc,2016,91(2):140-148.DOI:10.1016/j.mayocp.2015.10.021.
• [26]尉焱，安健，孔永梅，等.不稳定型心绞痛患者行不完全血运重建术后心脏康复干预效果研究[J].中国介入心脏病学杂志，2019,27(2):83-89.DOI:10.3969/j.issn.1004-8812.2019.02.005.