Coronary heart disease patient's concern on primary cardiac rehabilitation and its associated factors
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摘要: 目的 调查首次参加心脏康复(CR)的冠心病患者关注的CR相关问题及其社会因素，进而采取针对性教育措施，提高该类患者对CR的认知程度以达到CR的预防治疗效果。方法 采用半结构式调查问卷方式，纳入2021年10月—2022年1月就诊于北部战区总医院首次参加CR的冠心病患者210例进行研究。入选患者年龄(57.49±9.12)岁，男性169例(80.5%)。所有研究对象按照要求首先填写自己的姓名、年龄、性别、文化程度、医疗保险类型，然后在给定的16个CR问题(其中第16项为开放式问题)中勾选出至少5项自己最为关心的CR相关问题，汇总所有已勾选问题的次数，用于统计分析。依据年龄分布、性别差异、文化程度、经济条件、冠心病类型以及手术方式等分组条件对患者关注的问题数量及种类分布进行分析，探究在不同分组中患者关注问题的差异。结果 患者共选出关注的CR问题1250个，CR的认识、做法、好处、不良反应以及花费相关问题占比分别为23.9%(299/1250)、41.7%(521/1250)、11.4%(143/1250)、13.6%(170/1250)以及9.4%(117/1250)，暂无患者勾选开放式问题。患者最为关心的问题是CR的好处，关心最少的问题是CR的花费。男性患者关注CR问题的数量多于女性患者，二者差异具有统计学意义(Z=-2.207，P=0.027)。具有高中及以上文化程度的患者关注CR问题的数量多于初中及以下文化程度的患者(Z=-2.349，P=0.019)，并且该类患者更关心CR做法的相关问题(χ2=13.752，P=0.008)。在其他分组条件下，两组患者关注CR问题的数量和种类分布均无明显统计学差异。结论 首次参加CR患者关注CR问题因不同性别和文化程度而有所不同。因此，康复医生应当充分理解社会因素对患者的影响，采取针对性教育措施，提高患者参与CR的积极性和依从性。Abstract: Objective To investigate the cardiac rehabilitation (CR)-related problem and social factors of patients with coronary heart disease who participated in CR for the first time, and then take targeted educational measures to improve their cognitive level of CR in order to achieve the preventive effect of CR.Methods Semi-structured questionnaire was used. A total of 210 patients with coronary heart disease who attended CR for the first time in General Hospital of Northern Theater Command from October 2021 to January 2022 were enrolled. The age of the patients was (57.49±9.12) years old, and 169 cases (80.5%) were male. All subjects were asked to fill in their name, age, sex, education degree, and medical insurance type, and then check at least five of the questions they were most concerned about from a given list of 16 CR questions (item 16 was an open question). The frequency of checked questions was summarized for statistical analysis. Based on age, gender, education degree, economic condition, coronary heart disease types, and operation method, the number and distribution of questions were analyzed to explore the differences between the patients in different groups.Results A total of 1250 questions about CR were collected from the eligible patients. The cognition, methods, benefits, adverse effects and cost-related problems of CR accounted for 23.9% (299/1250), 41.7% (521/1250), 11.4% (143/1250), 13.6% (170/1250) and 9.4% (117/1250), respectively. The open question was not chosen. Patients were most concerned about the benefits of CR and least concerned about the cost. Male patients paid more attention to CR than female patients with statistically significant differences (Z=－2.207, P=0.027). Patients with high school education or above were more concerned about CR than those with junior high school education or below (Z=－2.349, P=0.019), and such patients were more concerned about CR methods (χ2=13.752, P=0.008). Under other conditions, there were no statistically significant differences in the number and distribution of questions about CR between the two groups.Conclusion The questions about CR among patients who participated in the CR for the first time varied with gender and education degree. Therefore, therapists should fully understand the effect of social associated factors on patients and take targeted educational measures to improve the motivation and adherence of patients in CR.
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Key words:
- coronary heart disease /
- cardiac rehabilitation /
- questionnaire survey /
- education
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表 1 冠心病患者关注的CR相关问题
Table 1. CR related questions concerned by patients with coronary heart disease
类别 问题 问题内容 例数 CR的认识 问题1 为什么要进行CR？ 63 问题2 CR是什么？ 115 问题3 术后多长时间可以做CR？ 61 问题4 CR适应于我的病情吗？ 60 299(合计) CR的做法 问题5 CR共包括哪些项目？ 101 问题6 每次CR大概需要花多长时间？ 73 问题7 每周应该至少进行几次CR训练呢？ 77 问题8 每次CR的训练强度应该有多大？ 79 问题9 CR的主要方法分别都有什么用处？ 88 问题10 CR大概得训练多长时间才能达到效果？ 103 521(合计) CR的好处 问题11 CR对疾病治疗及预防有什么好处？ 143 143(合计) CR的不良反应 问题12 CR会不会加重我的病情 74 问题13 CR有没有危险 96 170(合计) CR的花费 问题14 完成一个疗程的CR大概需要花费多少钱 45 问题15 CR的花费可以报销吗 72 117(合计) 其他 问题16 0 
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Table 2. Number and distribution of CR related questions concerned by patients with coronary heart disease
个 项目 男性(169例) 女性(41例) χ2/Z值 P值 CR问题数量 5(5，6) 5(5，5) -2.207 0.027 CR问题分布 5.367 0.252 CR的认识 244 55 CR的做法 429 92 CR的好处 116 27 CR的不良反应 141 29 CR的花费 86 31 项目 在职人员(117例) 退休人员(93例) χ2/Z值 P值 CR问题数量 5(5，6) 5(5，6) -0.972 0.331 CR问题分布 1.162 0.884 CR的认识 161 138 CR的做法 299 222 CR的好处 79 64 CR的不良反应 97 73 CR的花费 64 53 项目 高中及以上(114例) 初中及以下(96例) χ2/Z值 P值 CR问题数量 5(5，7) 5(5，6) -2.349 0.019 CR问题分布 13.752 0.008 CR的认识 174 125 CR的做法 322 199 CR的好处 72 71 CR的不良反应 82 88 CR的花费 62 55 项目 城镇医疗(139例) 农村医疗(62例) χ2/Z值 P值 CR问题数量 5(5，6) 5(5，6) -0.858 0.391 CR问题分布 2.976 0.562 CR的认识 205 75 CR的做法 351 140 CR的好处 92 44 CR的不良反应 111 54 CR的花费 78 37 项目 UA(201例) NSTEMI(9例) χ2/Z值 P值 CR问题数量 5(5，6) 6(5，6) -1.053 0.292 CR问题分布 5.570 0.234 CR的认识 287 12 CR的做法 503 18 CR的好处 137 6 CR的不良反应 157 13 CR的花费 112 5 项目 PCI(150例) 非PCI(60例) χ2/Z值 P值 CR问题数量 5(5，6) 5(5，6) -0.399 0.690 CR问题分布 9.290 0.054 CR的认识 213 86 CR的做法 360 161 CR的好处 99 44 CR的不良反应 133 37 CR的花费 93 24
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表 3 冠心病患者关注CR做法的分布特点
Table 3. Distribution characteristics of CR related methods concerned by patients with coronary heart disease
个 项目 男性(169例) 女性(41例) χ2/Z值 P值 CR项目内容 85 16 2.022 0.846 每次CR时间 58 15 每周CR次数 65 12 每次CR强度 62 17 各CR方法的用处 72 16 CR总时间 87 16 项目 在职人员(117例) 退休人员(93例) χ2/Z值 P值 CR项目内容 54 47 3.067 0.690 每次CR时间 41 32 每周CR次数 46 31 每次CR强度 41 38 各CR方法的用处 53 35 CR总时间 64 39 项目 高中及以上(114例) 初中及以下(96例) χ2/Z值 P值 CR项目内容 62 39 3.162 0.675 每次CR时间 47 26 每周CR次数 53 24 每次CR强度 46 33 各CR方法的用处 55 33 CR总时间 59 44 项目 城镇医疗(139例) 农村医疗(62例) χ2/Z值 P值 CR项目内容 71 25 4.853 0.434 每次CR时间 52 17 每周CR次数 57 16 每次CR强度 52 22 各CR方法的用处 56 26 CR总时间 63 34 项目 UA(201例) NSTEMI(9例) χ2/Z值 P值 CR项目内容 98 3 5.000 0.416 每次CR时间 69 4 每周CR次数 75 2 每次CR强度 74 5 各CR方法的用处 85 3 CR总时间 102 1 项目 PCI(150例) 非PCI(60例) χ2/Z值 P值 CR项目内容 68 33 1.643 0.896 每次CR时间 53 20 每周CR次数 56 21 每次CR强度 53 26 各CR方法的用处 58 30 CR总时间 72 31
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[1] 中国康复医学会心血管病专业委员会. 中国心脏康复与二级预防指南2018精要[J]. 中华内科杂志, 2018, 57(11): 802-810. doi: 10.3760/cma.j.issn.0578-1426.2018.11.003
[2] McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease[J]. Trends Cardiovasc Med, 2017, 27(6): 420-425. doi: 10.1016/j.tcm.2017.02.005
[3] Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis[J]. J Am Coll Cardiol, 2016, 67(1): 1-12. doi: 10.1016/j.jacc.2015.10.044
[4] Dibben GO, Dalal HM, Taylor RS, et al. Cardiac rehabilitation and physical activity: systematic review and meta-analysis[J]. Heart, 2018, 104(17): 1394-1402. doi: 10.1136/heartjnl-2017-312832
[5] Francis T, Kabboul N, Rac V, et al. The effect of cardiac rehabilitation on health-related quality of life in patients with coronary artery disease: a meta-analysis[J]. Can J Cardiol, 2019, 35(3): 352-364. doi: 10.1016/j.cjca.2018.11.013
[6] 安仁芳, 苏晓灵. 高海拔地区心脏康复的现状与展望[J]. 临床心血管病杂志, 2021, 37(1): 87-90. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202101019.htm
[7] Leon AS, Franklin BA, Costa F, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation[J]. Circulation, 2005, 111(3): 369-376. doi: 10.1161/01.CIR.0000151788.08740.5C
[8] Balady GJ, Ades PA, Bittner VA, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association[J]. Circulation, 2011, 124(25): 2951-2960. doi: 10.1161/CIR.0b013e31823b21e2
[9] Lolley R, Forman DE. Cardiac rehabilitation and survival for ischemic heart disease[J]. Curr Cardiol Rep, 2021, 23(12): 184. doi: 10.1007/s11886-021-01616-x
[10] Dibben G, Faulkner J, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease[J]. Cochrane Database Syst Rev, 2021, 11(11): CD001800.
[11] Gaglia MA Jr, Torguson R, Lipinski MJ, et al. Frequency of angina pectoris after percutaneous coronary intervention and the effect of metallic stent type[J]. Am J Cardiol, 2016, 117(4): 526-531. doi: 10.1016/j.amjcard.2015.11.036
[12] Tian Y, Deng P, Li B, et al. Treatment models of cardiac rehabilitation in patients with coronary heart disease and related factors affecting patient compliance[J]. Rev Cardiovasc Med, 2019, 20(1): 27-33. doi: 10.31083/j.rcm.2019.01.53
[13] Smith JR, Thomas RJ, Bonikowske AR, et al. Sex differences in cardiac rehabilitation outcomes[J]. Circ Res, 2022, 130(4): 552-565. doi: 10.1161/CIRCRESAHA.121.319894
[14] Kianoush S, Al Rifai M, Patel J, et al. Association of participation in cardiac rehabilitation with social vulnerability index: The behavioral risk factor surveillance system[J]. Prog Cardiovasc Dis, 2022, 71: 86-91. doi: 10.1016/j.pcad.2022.02.003
[15] 沈珈谊, 王苏英, 李珊, 等. 浙江省社区中老年人群冠心病患病率调查及危险因素分析[J]. 临床心血管病杂志, 2020, 36(9): 805-809. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202009006.htm
[16] Chindhy S, Taub PR, Lavie CJ, et al. Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers[J]. Expert Rev Cardiovasc Ther, 2020, 18(11): 777-789. doi: 10.1080/14779072.2020.1816464
[17] Jackson JL, Emery CF. Emotional distress, alexithymia, and coping as predictors of cardiac rehabilitation outcomes and attendance[J]. J Cardiopulm Rehabil Prev, 2013, 33(1): 26-32. doi: 10.1097/HCR.0b013e318276864c
[18] Zhou Y, Li J, Du S, et al. Cardiac rehabilitation knowledge in patients with coronary heart disease in Baoding city of China: A cross-sectional study[J]. Int J Nurs Sci, 2017, 4(1): 24-28.
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