较低社会经济地位的患者在进入心脏康复治疗时具有极高的风险因素
Sherrie Khadanga1, Patrick D Savage, Philip A Ades
1University of Vermont Medical Center, Burlington (Drs Khadanga and Ades and Messrs Savage and Anair); and University of Vermont, Burlington (Mr Yant, Ms Kromer, and Dr Gaalema).
Journal of cardiopulmonary rehabilitation and prevention
|October 11, 2023
概括
具有较低社会经济地位 (SES) 的患者面临更高的心血管风险,不太可能参加心脏康复 (CR). 这项研究突出了它们独特的高风险概况,强调了有针对性的CR参与战略的必要性.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 健康差异 在健康上的差异
背景情况:
- 具有较低社会经济地位 (SES) 的患者患心血管事件的比率不成比例地高.
- 较低的SES与减少参与心脏康复 (CR) 等二级预防计划的参与有关.
- 鉴定CR中较低SES患者的独特风险因素是具有挑战性的,因为入学率低.
研究的目的:
- 为了比较低和高SES患者之间的医疗,心理和行为风险因素,符合二次预防的资格.
- 描述CR计划中较低SES患者的高风险概况,成功增加了他们的招聘.
- 为低SES个人在CR中确定具体的干预领域.
主要方法:
- 关于从2014年到2022年连续进入CR第二阶段的患者的前性数据收集.
- 以医疗补助保险身份为基础的较低SES的分类.
- 使用奇平方和非对对的t试验进行统计分析,显著性设置在P < .01.
主要成果:
- 较低SES患者 (13%的3131队列) 较年轻 (57岁对67岁),但目前吸烟率较高 (29%对5%),抑郁症状升高 (1.7倍),心脏代谢标志物 (BMI,腰围,HbA1c,脂质) 更差).
- 尽管年轻,但低SES患者表现出较低的心肺呼吸能力和自我报告的身体功能.
- 这些发现具有统计学意义 (所有P<.001).
结论:
- 低SES患者呈现显著更高的心血管疾病风险概况,表明冠状动脉事件复发的可能性更大.
- 加强参与战略对于将这些高风险人群纳入CR至关重要.
- 必须配备CR计划,以应对低SES患者中普遍存在的可修改的风险因素,包括体质不佳,肥胖,抑郁和吸烟.
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