老年冠心病患者心脏康复治疗的基本概念讲述.pptVIP

ACS后CR获益的证据 HM734 Exercise Testing and Prescription: Cardiorespiratory * 迄今，一项最大的荟萃分析入选了47个随机化研究，共10794例，比较了基于运动的心脏康复与常规治疗的优劣。 中长期随访（12个月以上），基于运动的心脏康复降低 总体死亡率[RR 0.87 (95% CI 0.75, 0.99)，（3年死亡率下降20~25%） 和心血管死亡率[0.74 (95% CI 0.63, 0.87)] 。 10个涉及到与健康相关生活质量的研究，其中7个研究强烈的证据表明，基于运动的心脏康复治疗比常规治疗明显提高了ACS患者的生活质量。 HM734 Exercise Testing and Prescription: Cardiorespiratory * The ENRICHD Intervention Did Improve Late Survival (6 Months) Late survival depended on whether depression improved over the course of the intervention. Carney et al., Psychosom Med 2004;66(4):466-474. HM734 Exercise Testing and Prescription: Cardiorespiratory * Arch Intern Med. 2008;168(20):2194-2204. doi:10.1001/archinte.168.20.2194 HM734 Exercise Testing and Prescription: Cardiorespiratory * Depression is Associated with Decreased Survival Actuarial cumulative hazard plot for survival time based on depression status upon completion of cardiac rehabilitation Depressed Non-depressed 0 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0 1 2 3 4 5 Time (Years) Milani RV, Am J Med 2007 HM734 Exercise Testing and Prescription: Cardiorespiratory * Psychological Distress is Common Prevalence of Depression Before and After Cardiac Rehab 23% 19% 30 20 0 Young Elderly 10 6% 4% Before After Lavie CF, Arch Int Med, 2006 HM734 Exercise Testing and Prescription: Cardiorespiratory * 34 HM734 Exercise Testing and Prescription: Cardiorespiratory * * * * * So these are the people that we envisage should be involved with secondary prevenion according to the NSF for CHD. * RFA list Family * Cumulative Kaplan-Meier estimates of the rates of key study end points during the follow-up period among 3241 patients with recent myocardial infarction (MI). A, Data for the primary composite end point (cardiovascular mortality, nonfatal MI, nonfatal stroke, and hospitalization for angina pectoris, heart failure, or urgent revascularization procedure). The hazard ratio (HR) for the intensive intervention, compared with usual care, for the prim