Exploration and Implementation of Management Path of Community/Home-based Cardiac Rehabilitation

doi:10.12114/j.issn.1007-9572.2019.00.355

Abstract

Abstract: In recent years，hospital-based cardiac rehabilitation in China has developed rapidly，but community/home-based cardiac rehabilitation has hardly been carried out，and the rate of patients with acute myocardial infarction（AMI） receiving such rehabilitation is very low.We detailedly discussed how to deliver community/home-based safe and effective cardiac rehabilitation for post-discharge AMI patients，to main their exercise habit associated with treatment，develop an exercise-centered health-promoting lifestyle，adhere to use pharmacological treatment for secondary prevention of cardiovascular events，ensure a good mental state，and return to work and social life.Moreover，we discussed the community/home-based models suitable for delivering cardiac rehabilitation for AMI patients in China，including developing structured exercise prescriptions and the simplification method，and ways for maintaining diversification and amusement of community/home-based exercise training forms，by which the enthusiasm of AMI patients in participating in community/home-based cardiac rehabilitation can be increased，the recurrence rate and case fatality rate of acute cardiovascular events in AMI patients can be decreased.

Key words: Cardiac rehabilitation, Myocardial infarction, Community health services, Management path

摘要： 近年来我国医院的心脏康复发展迅速，但社区/家庭心脏康复几乎没有开展，尤其是急性心肌梗死患者参与心脏康复治疗率较低。本文重点探讨急性心肌梗死患者出院后如何在社区/家庭进行安全而有效的心脏康复，以维持患者的运动治疗习惯，建立以运动为核心的生活方式，促进其坚持二级预防用药，保证良好的心理状态，恢复社会生活和工作。此外，本文还探讨了适合我国急性心肌梗死患者在社区/家庭实施心脏康复的模式，包括建立结构化运动处方及其易化方法，保持社区/家庭心脏康复运动训练形式多样化和趣味性，进而增加患者在社区/家庭运动训练的主动性，提高我国冠心病患者在急性心肌梗死治疗后的心脏康复参与率，降低急性心血管事件复发率和病死率。

关键词: 心脏康复, 心肌梗死, 社区卫生服务, 管理路径

ZHANG Zhaoguo,JIANG Hongyan,WANG Yanhui, et al. Exploration and Implementation of Management Path of Community/Home-based Cardiac Rehabilitation　[J]. Chinese General Practice, 2019, 22(31): 3779-3785. DOI: 10.12114/j.issn.1007-9572.2019.00.355.
张兆国,姜红岩,王彦辉等. 社区/家庭心脏康复管理模式与路径研究[J]. 中国全科医学, 2019, 22(31): 3779-3785. DOI: 10.12114/j.issn.1007-9572.2019.00.355.

References

［1］SQUIRES R W，KAMINSKY L A，PORCARI J P，et al．Progression of exercise training in early outpatient cardiac rehabilitation：an official statement from the american association of cardiovascular and pulmonary rehabilitation［J］．J Cardiopulm Rehabil Prev，2018，38（3）：139-146．DOI：10.1097/HCR.0000000000000337.
［2］中华医学会心血管病学分会，中国康复医学会心血管病专业委员会，中国老年学学会心脑血管病专业委员会.冠心病康复与二级预防中国专家共识［J］．中华心血管病杂志，2013，41（4）：267-275.
Chinese Society of Cardiology，Cardiovascular Committee of Chinese Association of Rehabilitation Medicine，Chinese Society of Gerontology Cardio-cerebrovascular Disease Committee.Chinese expert consensus on rehabilitation and secondary prevention of coronary heart disease［J］．Chin J Cardiol，2013，41（4）：267-275.
［3］WALTHER C，M?BIUS-WINKLER S，LINKE A，et al．Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease［J］．Eur J Cardiovasc Prev Rehabil，2008，15（1）：107-112．DOI：10.1097/HJR.0b013e3282f29aa6.
［4］THOMAS R J，KING M，LUI K，et al．AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services［J］．Journal of Cardiopulmonary Rehabilitation and Prevention，2007，27（5）：260-290．DOI：10.1097/01.hcr.0000291295.24776.7b.
［5］李娟，吴宏艳.美日心脏康复对比思考之中国心脏康复发展启示［J］．中西医结合心血管病电子杂志，2018，6（3）：3.
LI J，WU H Y.Comparison of cardiac rehabilitation in America and Japan and its enlightenment to China［J］．Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine，2018，6（3）：3.
［6］健康时报.我国心脏康复迫在眉睫［N］．2012-10-18（01）.
［7］THOMAS R J，BEATTY A L，BECKIE T M，et al．Home-based cardiac rehabilitation［J］．Journal of Cardiopulmonary Rehabilitation and Prevention，2019：1．DOI：10.1097/hcr.0000000000000447.
［8］丁荣晶.中国心脏康复现状和发展［EB/OL］．（2018-02-04）［2019-01-10］．https：//mip.haodf.com/zhuanjiaguandian/5786113381.htm.
［9］丁荣晶，高立敏，褚亮，等．三级医院指导下社区主导的家庭自助心脏康复模式的有效性和安全性［J］．中华心血管病杂志，2017，45（3）：209-221．DOI：10.3760/cma.j.issn.0253-3758.2017.03.008.
DING R J，GAO L M，CHU L，et al．Efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model［J］．Chinese Journal of Cardiology，2017，45（3）：209-221．DOI：10.3760/cma.j.issn.0253-3758.2017.03.008.
［10］NEUBECK L，REDFERN J，FREEDMAN S B.Letter by neubeck et al regarding article，"impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community"［J］．Circulation，2011，124（22）：e572．DOI：10.1161/circulationaha.111.046961.
［11］CLAES J，BUYS R，WOODS C，et al．Pathway Ⅰ：design and rationale for the investigation of the feasibility，clinical effectiveness and cost-effectiveness of a technology-enabled cardiac rehabilitation platform［J］．BMJ Open，2017，7（6）：e016781．DOI：10.1136/bmjopen-2017-016781.
［12］THOMAS R J，BALADY G，BANKA G，et al．2018 ACC/AHA clinical performance and quality measures for cardiac rehabilitation［J］．J Am Coll Cardiol，2018，71（16）：1814-1837．DOI：10.1016/j.jacc.2018.01.004.
［13］BUCKINGHAM S A，TAYLOR R S，JOLLY K，et al．Home-based versus centre-based cardiac rehabilitation：abridged Cochrane systematic review and meta-analysis［J］．Open Heart，2016，3（2）：e000463．DOI：10.1136/openhrt-2016-000463.
［14］MARANH?O-NETO G D E A，LEON A C，FARINATTI P D E T.Validity and equivalence of the Portuguese version of the Veterans Specific Activity Questionnaire［J］．Arq Bras Cardiol，2011，97（2）：130-135．DOI：10.1590/s0066-782x2011005000071.
［15］MYERS J，BADER D，MADHAVAN R，et al．Validation of a specific activity questionnaire to estimate exercise tolerance in patients referred for exercise testing［J］．Am Heart J，2001，142（6）：1041-1046．DOI：10.1067/mhj.2001.118740.
［16］BEATTY A L，TRUONG M，SCHOPFER D W，et al．Geographic variation in cardiac rehabilitation participation in medicare and veterans affairs populations：opportunity for improvement［J］．Circulation，2018，137（18）：1899-1908．DOI：10.1161/CIRCULATIONAHA.117.029471.
［17］ANDERSON L，OLDRIDGE N，THOMPSON D R，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.

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