RESUMEN
BACKGROUND: Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) is a Class I recommendation. Although referral to CR after an AMI has recently become a performance measure, many patients may not participate. To illuminate potential barriers to participation, we examined the prevalence of, and patient-related factors associated with, CR participation within 1 and 6 months after an AMI. METHODS AND RESULTS: We studied 2096 AMI patients enrolled from 19 US sites in the Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery (PREMIER) registry. Analyses were limited to those patients referred for CR at the time of AMI hospitalization. A multivariable, conditional logistic regression model, stratified by hospital, was used to identify sociodemographic, comorbidity, and clinical factors independently associated with CR participation within 1 and 6 months of AMI hospital discharge. Only 29% (419/1450) and 48.25% (650/1347) of AMI patients who received referral for CR participated within 1 and 6 months after discharge, respectively. Women (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.44-0.86), uninsured (OR, 0.39; 95% CI, 0.21-0.71), and patients with hypertension (OR, 0.58; 95% CI, 0.43-0.78) and peripheral arterial disease (OR, 0.43; 95% CI, 0.22-0.85) were less likely to participate at 1 month. At 6 months after AMI, older patients (OR, 0.85 for each 10-year increment; 95% CI, 0.74-0.97), smokers (OR, 0.59; 95% CI, 0.44-0.80), and patients with economic burden (OR, 0.56; 95% CI, 0.38-0.81) were less likely to participate. Caucasians (OR, 1.73; 95% CI, 1.16-2.58) and educated patients (OR, 1.81; 95% CI, 1.42-2.30) were more likely to participate at 6 months. Patients with previous percutaneous interventions were less likely to participate at both 1 and 6 months post-AMI. CONCLUSIONS: Among patients referred for CR post-AMI, participation remains low both at 1 and 6 months after AMI. Because CR is associated with beneficial changes in cardiovascular risk factors and better outcomes after AMI, more aggressive efforts are needed to increase CR participation after referral.
Asunto(s)
Infarto del Miocardio/rehabilitación , Participación del Paciente/estadística & datos numéricos , Derivación y Consulta , Anciano , Comorbilidad , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Enfermedad Arterial Periférica/epidemiología , Sistema de Registros , Estudios Retrospectivos , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
El envejecimiento de la población en todo el mundo dará lugar a un número creciente de pacientes ancianos, en los que la cardiopatía es la principal causa de muerte. Las alteraciones de la fisiología cardiovascular con el envejecimiento normal y las comorbilidades causan diferencias en los problemas cardiacos y en la respuesta a los tratamientos en los pacientes ancianos. Los objetivos de la asistencia centrados en el paciente, como el mantenimiento de la independencia y la reducción de los síntomas, pueden ser más prioritarios que el aumento de la longevidad. Es probable que los nuevos tratamientos menos invasivos mejoren los resultados obtenidos en pacientes ancianos en los que antes se consideraba que el riesgo de los procedimientos tradicionales impedía su aplicación. Los ensayos clínicos en los que se ha incluido a pacientes ancianos son limitados y es frecuente que las recomendaciones de tratamiento basadas en pacientes de menor edad carezcan de respaldo en la evidencia para los pacientes de edad superior a 75 años (AU)
The aging of the population worldwide will result in increasing numbers of elderly patients, among whom heart disease is the leading cause of death. Changes in cardiovascular physiology with normal aging and prevalent comorbidities result in differences in the effects of common cardiac problems as well as the response to their treatments. Patient-centered goals of care such as maintenance of independence and reduction of symptoms may be preferred over increased longevity. New less-invasive treatments are likely to improve outcomes in elderly patients who previously have been considered at prohibitive risk for traditional procedures. Clinical trials enrolling elderly patients are limited and recommendations for management from younger patients frequently lack evidence-based support in patients aged >75 years (AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/prevención & control , Estenosis Aórtica Subvalvular/epidemiología , Estenosis Aórtica Subvalvular/prevención & control , Estenosis de la Válvula Aórtica/epidemiología , Cardiopatías/mortalidadRESUMEN
The aging of the population worldwide will result in increasing numbers of elderly patients, among whom heart disease is the leading cause of death. Changes in cardiovascular physiology with normal aging and prevalent comorbidities result in differences in the effects of common cardiac problems as well as the response to their treatments. Patient-centered goals of care such as maintenance of independence and reduction of symptoms may be preferred over increased longevity. New less-invasive treatments are likely to improve outcomes in elderly patients who previously have been considered at prohibitive risk for traditional procedures. Clinical trials enrolling elderly patients are limited and recommendations for management from younger patients frequently lack evidence-based support in patients aged >75 years.