老年心肌梗死患者出院后心脏康复依从性及影响因素分析

Analysis of compliance and influencing factors of cardiac rehabilitation in elderly patients with myocardial infarction after discharge

目的分析老年急性心肌梗死(AMI)患者出院后心脏康复依从性现状及影响因素,为提高心脏康复依从性提供参考。方法选取2020年1月—2021年12月于云南省第三人民医院就诊的264例老年AMI患者,在出院时对患者进行出院后心脏康复行为指导,并在出院后3个月采用一般资料调查量表及心脏康复量表调查,根据心脏康复情况分为依从性良好组(n=102)和依从性较差组(n=162)。分析影响老年AMI患者出院后心脏康复依从性的因素。结果与依从性较差组比较,依从性较好组心脏康复量表自主性评分较高,过程焦虑、结果焦虑的评分及自主性较差率、高过程焦虑率、高结果焦虑率均降低(P<0.05);依从性较差组和依从性良好组在文化程度、抑郁、对疾病感知情况、社会支持度、医护人员督促情况、医疗费用支付方式等差异有统计学意义(P<0.05);二元Logistic回归分析显示,初中及以下文化程度(OR=2.921)、抑郁(OR=3.212,P=0.001)、对疾病感知情况差(OR=2.547)、社会支持度差(OR=2.090)、医护人员督促情况差(OR=2.016)、自费(OR=2.214)、自主性较差(OR=3.751)、高过程焦虑(OR=3.254)、高结果焦虑(OR=2.591)均为老年AMI患者出院后心脏康复依从性较差的危险因素(P<0.05)。结论文化程度、抑郁、对疾病感知情况、社会支持度、医疗费用支付方式、医护人员督促情况可能是影响老年AMI患者出院后心脏康复依从性的因素,临床可针对上述因素给予干预,以提高患者心脏康复依从性。

Objective To analyze the current status and influencing factors of cardiac rehabilitation compliance in elderly patients with acute myocardial infarction(AMI)after discharge,and improve cardiac rehabilitation compliance.Methods A total of 264 elderly AMI patients treated in Third People s Hospital of Yunnan Province from January 2020 to December 2021 were selected.At the time of discharge,all patients were given post-discharge cardiac rehabilitation behavior guidance.Three months after discharge,they were investigated by self-designed general data questionnaire and cardiac rehabilitation scale.According to cardiac rehabilitation status,they were divided into poor compliance group(n=162)and good compliance group(n=102).The influencing factors of cardiac rehabilitation compliance in elderly patients with AMI after discharge were analyzed.Results Compared with the poor compliance group,the autonomy score of the cardiac rehabilitation scale of the good compliance group was higher,and the scores of process anxiety and outcome anxiety,and the ratio of poor autonomy,high process anxiety rate and high outcome anxiety rate were lower(P<0.05).There were statistically significant differences between the poor compliance group and the good compliance group in education level,depression,perception of disease,social support,supervision of medical staff and payment method of medical expenses(P<0.05).Binary Logistic regression analysis showed that educational level of junior high school and below(OR=2.921),depression(OR=3.212,P=0.001),poor disease perception(OR=2.547),low social support(OR=2.090),poor supervision of medical staffs(OR=2.016),self-paying(OR=2.214),poor autonomy(OR=3.751),high process anxiety(OR=3.254)and high outcome anxiety(OR=2.591)were risk factors of poor cardiac rehabilitation compliance in elderly AMI patients after discharge(P<0.05).Conclusion Education level,depression,disease perception,social support,supervision of medical staffs and payment methods for medical expenses may be factors that affect the cardiac rehabilitation compliance in elderly patients with AMI after discharge.Clinical interventions can be given based on the above factors to improve patients compliance with cardiac rehabilitation.