多中心急性心肌梗死患者心脏康复依从性及其相关影响因素分析

Analysis of cardiac rehabilitation adherence and its associated influencing factors in acute myocardial infarction patients

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3812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3812例患者其中依从组2090例(54.8%),不依从组1722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。

Objective To investigate the factors influencing cardiac rehabilitation(CR)adherence in patients with acute myocardial infarction(AMI).Methods A total of 3812 patients with AMI who were willing to participate in CR from 42 hospitals in China between January 15,2018 and September 17,2019 were consecutively enrolled,clinical baseline data were collected,and adherence was grouped according to the follow-up of cardiac rehabilitation at the 3rd and 12th months after discharge,and the population characteristics of these two groups were compared to derive the factors influencing adherence to CR in AMI patients using logistic regression analysis.Results A total of 3812 patients,including 2090(54.8%)in the adherence group and 1722(45.2%)in the non-adherence group,were analyzed by multifactorial Logistic regression analysis showing that education(elementary:OR 0.458,95%CI 0.359-0.584;middle:OR 0.593,95%CI 0.474-0.741;high school and secondary school:OR 0.775,95%CI 0.612-0.980),residence(urban:OR 1.250,95%CI 1.058-1.477),smoking(OR 1.349,95%CI 1.166-1.561),dyslipidemia(OR 1.300,95%CI 1.135-1.488),family history of coronary artery disease(OR 2.717,95%CI 1.842-4.007),history of percutaneous coronary intervention(PCI)procedure(OR 0.615,95%CI0.457-0.827),history of stroke(OR 0.755,95%CI 0.614-0.928)and revascularization methods[coronary stenting(CS):OR 2.184,95%CI 1.671-2.855]as their independent influences(all P<0.05).Conclusions Nearly half of the patients in the study had poor compliance.Education level,residence,smoking history,dyslipidemia,previous PCI history,family history of coronary heart disease,stroke history,and revascularization methods were independently correlated with CR compliance.