Heart:心脏康复治疗有长期益处

　　澳大利亚学者的一项研究表明，心脏康复治疗可对相关患者产生远期益处，并且可能存在剂量效应关系。论文于2012年12月4日在线发表于《心脏》（Heart）杂志。

　　此项回顾性队列研究共纳入544例心梗以及行冠脉搭桥术、经皮介入治疗的患者；受试者均适于接受心脏康复治疗。对出院患者进行随访以确定心脏康复治疗参与状况。主要转归指标为14年时的全因死亡率。

　　结果显示，281例（52%）患者至少参与一周期心脏康复治疗。心脏康复治疗参与者和未参与者无显著差异。对年龄、性别、诊断、就业、糖尿病和家族史进行校正后，未参与者的死亡风险较参与者升高58%[危险比（HR）1.58]。与参与康复治疗超过75%总周期的患者相比，<25%总周期的患者的死亡风险升高一倍以上（OR 2.57）。对当前吸烟状况进行校正之后相关性有所减弱（OR 2.06）。

Attendance at cardiac rehabilitation is associated with lower all-cause mortality after 14years of follow-up
Objective
To investigate whether attendance at cardiac rehabilitation (CR) independently predicts all-cause mortality over 14years and whether there is a dose–response relationship between the proportion of CR sessions attended and long-term mortality.
Design
Retrospective cohort study.
Setting
CR programmes in Victoria, Australia
Patients
The sample comprised 544 men and women eligible for CR following myocardial infarction, coronary artery bypass surgery or percutaneous interventions. Participants were tracked 4months after hospital discharge to ascertain CR attendance status.
Main outcome measures
All-cause mortality at 14years ascertained through linkage to the Australian National Death Index.
Results
In total, 281 (52%) men and women attended at least one CR session. There were few significant differences between non-attenders and attenders. After adjustment for age, sex, diagnosis, employment, diabetes and family history, the mortality risk for non-attenders was 58% greater than for attenders (HR=1.58, 95% CI 1.16 to 2.15). Participants who attended <25% of sessions had a mortality risk more than twice that of participants attending ≥75% of sessions (OR=2.57, 95% CI 1.04 to 6.38). This association was attenuated after adjusting for current smoking (OR=2.06, 95% CI 0.80 to 5.29).
Conclusions
This study provides further evidence for the long-term benefits of CR in a contemporary, heterogeneous population. While a dose–response relationship may exist between the number of sessions attended and long-term mortality, this relationship does not occur independently of smoking differences. CR practitioners should encourage smokers to attend CR and provide support for smoking cessation.