心脏康复对老年冠心病患者的影响及现状
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摘要
目前冠心病是全世界最主要的死亡原因之一。高龄与冠心病的患病率、发病率和死亡率增加有关。和年轻患者相比,老年人在出现心血管事件后发生并发症和身体加速恶化的风险更高。既往冠心病都以药物、手术治疗为主,近些年研究者提出基于运动的心脏康复是冠心病患者治疗的重要组成部分,特别对老年患者能改善其生活质量。本综述总结了目前有关心脏康复对老年冠心病人群的影响及现状。
Coronary heart disease is one of the leading causes of death worldwide. Advanced age is associated with increased prevalence,morbidity and mortality of coronary heart disease. Older adults are at higher risk of complications and accelerated physical deterioration following cardiovascular events than younger patients. In recent years,researchers have proposed that exercise-based cardiac rehabilitation is an important part of the treatment of patients with coronary heart disease,especially contributing to the improvement of the quality of life of elderly patients. This review summarizes the current status and influence of cardiac rehabilitation on elderly patients with coronary heart disease.
Coronary heart disease is one of the leading causes of death worldwide. Advanced age is associated with increased prevalence,morbidity and mortality of coronary heart disease. Older adults are at higher risk of complications and accelerated physical deterioration following cardiovascular events than younger patients. In recent years,researchers have proposed that exercise-based cardiac rehabilitation is an important part of the treatment of patients with coronary heart disease,especially contributing to the improvement of the quality of life of elderly patients. This review summarizes the current status and influence of cardiac rehabilitation on elderly patients with coronary heart disease.
引文
[1]Thomas H,Diamond J,Vieco A,et al.Global Atlas of Cardiovascular Disease 2000-2016:The Path to Prevention and Control[J].Glob Heart,2018,13(3):143-163.DOI:10.1016/j.gheart.2018.09.511.
[2]Jiang L,Krumholz HM,Li X,et al.Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system[J].Lancet,2015,386(10002):1493-1505.DOI:10.1016/S0140-6736(15)00343-8.
[3]Powell R,Mc Gregor G,Ennis S,et al.Is exercise-based cardiac rehabilitation effective?A systematic review and meta-analysis to re-examine the evidence[J].BMJ Open,2018,8(3):e019656.DOI:10.1136/bmjopen-2017-019656.
[4]Anderson L,Oldridge N,Thompson DR,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.
[5]Turk-Adawi K,Sarrafzadegan N,Grace SL.Global availability of cardiac rehabilitation[J].Nat Rev Cardiol,2014,11(10):586-596.DOI:10.1038/nrcardio.2014.98.
[6]Huang K,Liu W,He D,et al.Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease:Asystematic review and meta-analysis[J].Eur J Prev Cardiol,2015,22(8):959-971.DOI:10.1177/2047487314561168.
[7]Vigorito C,Abreu A,Ambrosetti M,et al.Frailty and cardiac rehabilitation:A call to action from the EAPC Cardiac Rehabilitation Section[J].Eur J Prev Cardiol,2017,24(6):577-590.DOI:10.1177/2047487316682579.
[8]van Dam van Isselt EF,van Wijngaarden J,DJA L,et al.Geriatric rehabilitation in older patients with cardiovascular disease:a feasibility study[J].Eur Geriatr Med,2018,9(6):853-861.DOI:10.1007/s41999-018-0119-2.
[9]Cao RY,Zheng H,Mi Q,et al.Aerobic exercise-based cardiac rehabilitation in Chinese patients with coronary heart disease:study protocol for a pilot randomized controlled trial[J].Trials,2018,19(1):363.DOI:10.1186/s13063-018-2771-8.
[10]Hansen D,Stevens A,Eijnde BO,et al.Endurance exercise intensity determination in the rehabilitation of coronary artery disease patients:a critical re-appraisal of current evidence[J].Sports Med,2012,42(1):11-30.DOI:10.2165/11595460-000000000-00000.
[11]中华医学会老年医学分会75岁及以上稳定性冠心病患者运动康复中国专家共识写作组.75岁及以上稳定性冠心病患者运动康复中国家共识[J].中华老年医学杂志,2017,36(6):599-607.DOI:10.3760/cma.j.issn.0254-9026.2017.06.001.
[12]American Association of Cardiovascular and Pulmonary Rehabilitation.Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs[M].5th ed.Champaign,IL:Human Kinetics,2013:1730.
[13]Piepoli MF,CorràU,Benzer W,et al.Secondary prevention through cardiac rehabilitation:from knowledge to implementation.A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation[J].Eur J Cardiovasc Prev Rehabil,2010,17(1):1-17.DOI:10.1097/HJR.0b013e3283313592.
[14]Turk-Adawi KI,Terzic C,Bjarnason-Wehrens B,et al.Cardiac rehabilitation in Canada and Arab countries:comparing availability and program characteristics[J].BMC Health Serv Res,2015,15:521.DOI:10.1186/s12913-015-1183-7.
[15]Woodruffe S,Neubeck L,Clark RA,et al.Australian Cardiovascular Health and Rehabilitation Association(ACRA)core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014[J].Heart Lung Circ,2015,24(5):430-441.DOI:10.1016/j.hlc.2014.12.008.
[16]JCS Joint Working Group.Guidelines for rehabilitation in patients with cardiovascular disease(JCS 2012)[J].Circ J,2014,78(8):2022-2093.
[17]Milanovic'Z,SporisˇG,Weston M.Effectiveness of High-Intensity Interval Training(HIT)and Continuous Endurance Training for VO2max Improvements:A Systematic Review and Meta-Analysis of Controlled Trials[J].Sports Med,2015,45(10):1469-1481.DOI:10.1007/s40279-015-0365-0.
[18]Liou K,Ho S,Fildes J,et al.High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease:A Meta-analysis of Physiological and Clinical Parameters[J].Heart Lung Circ,2016,25(2):166-174.DOI:10.1016/j.hlc.2015.06.828.
[19]Pavy B,Iliou MC,Vergès-Patois B,et al.French Society of Cardiology guidelines for cardiac rehabilitation in adults[J].Arch Cardiovasc Dis,2012,105(5):309-328.DOI:10.1016/j.acvd.2012.01.010.
[20]Mc Gregor G,Nichols S,Hamborg T,et al.High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes(HIIT or MISS UK):study protocol for a multicentre randomised controlled trial and economic evaluation[J].BMJ Open,2016,6(11):e012843.DOI:10.1136/bmjopen-2016-012843.
[21]Williams MA,Maresh CM,Esterbrooks DJ,et al.Early exercise training in patients older than age 65 years compared with that in younger patients after acute myocardial infarction or coronary artery bypass grafting[J].Am J Cardiol,1985,55(4):263-266.
[22]Lavie CJ,Milani RV,Littman AB.Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly[J].J Am Coll Cardiol,1993,22(3):678-683.
[23]Menezes AR,Lavie CJ,Milani RV,et al.Cardiac rehabilitation and exercise therapy in the elderly:Should we invest in the aged?[J].J Geriatr Cardiol,2012,9(1):68-75.DOI:10.3724/SP.J.1263.2012.00068.
[24]Suaya JA,Stason WB,Ades PA,et al.Cardiac rehabilitation and survival in older coronary patients[J].J Am Coll Cardiol,2009,54(1):25-33.DOI:10.1016/j.jacc.2009.01.078.
[25]Doll JA,Hellkamp A,Thomas L,et al.Effectiveness of cardiac rehabilitation among older patients after acute myocardial infarction[J].Am Heart J,2015,170(5):855-864.DOI:10.1016/j.ahj.2015.08.001.
[26]Flint K,Kennedy K,Arnold SV,et al.Slow Gait Speed and Cardiac Rehabilitation Participation in Older Adults After Acute Myocardial Infarction[J].J Am Heart Assoc,2018,7(5).pii:e008296.DOI:10.1161/JAHA.117.008296.
[27]Lawler PR,Filion KB,Eisenberg MJ.Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction:a systematic review and meta-analysis of randomized controlled trials[J].Am Heart J,2011,162(4):571-584.e2.DOI:10.1016/j.ahj.2011.07.017.
[28]Taylor RS,Brown A,Ebrahim S,et al.Exercise-based rehabilitation for patients with coronary heart disease:systematic review and meta-analysis of randomized controlled trials[J].Am J Med,2004,116(10):682-692.DOI:10.1016/j.amjmed.2004.01.009.
[29]孙佩伟,李运田,宋成运,等.运动康复对老年稳定性冠心病患者危险因素的长期随访研究[J].中华老年心脑血管病杂志,2016,18(5):491-495.DOI:10.3969/j.issn.1009-0126.2016.05.013.
[30]van Halewijn G,Deckers J,Tay HY,et al.Lessons from contemporary trials of cardiovascular prevention and rehabilitation:A systematic review and meta-analysis[J].Int J Cardiol,2017,232:294-303.DOI:10.1016/j.ijcard.2016.12.125.
[31]Roohafza H,Sadeghi M,Khani A,et al.Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses[J].Int J Nurs Pract,2015,21(2):214-220.DOI:10.1111/ijn.12234.
[32]徐维芳,陈柄泉,彭智勇,等.综合医院心血管内科门诊患者失眠症发生率及其影响因素[J].中国医师杂志,2018,20(1):96-99.DOI:10.3760/cma.j.issn.1008-1372.2018.01.024.
[33]Meyer FA,Hugentobler E,Stauber S,et al.Depressive symptoms at discharge from rehabilitation predict future cardiovascular-related hospitalizations[J].Cardiology,2015,131(2):80-85.DOI:10.1159/000375231.
[34]Turk-Adawi K,Sarrafzadegan N,Grace SL.Global availability of cardiac rehabilitation[J].Nat Rev Cardiol,2014,11(10):586-596.DOI:10.1038/nrcardio.2014.98.
[35]Bjarnason-Wehrens B,Mc Gee H,Zwisler AD,et al.Cardiac rehabilitation in Europe:results from the European Cardiac Rehabilitation Inventory Survey[J].Eur J Cardiovasc Prev Rehabil,2010,17(4):410-418.DOI:10.1097/HJR.0b013e328334f42d.
[36]Anchique SCV,Lopez-Jimenez F,Benaim B,et al.Cardiac rehabilitation in Latin America[J].Prog Cardiovasc Dis,2014,57(3):268-275.DOI:10.1016/j.pcad.2014.09.006.
[37]Lawler PR,Filion KB,Eisenberg MJ.Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction:a systematic review and meta-analysis of randomized controlled trials[J].Am Heart J,2011,162(4):571-584.e2.DOI:10.1016/j.ahj.2011.07.017.
[38]Dalal HM,Doherty P,Taylor RS.Cardiac rehabilitation[J].BMJ,2015,351:h5000.DOI:10.1136/bmj.h5000.
[39]Barber K,Stommel M,Kroll J,et al.Cardiac rehabilitation for community-based patients with myocardial infarction:factors predicting discharge recommendation and participation[J].J Clin Epidemiol,2001,54(10):1025-1030.
[40]Matata BM,Williamson SA.A Review of Interventions to Improve Enrolment and Adherence to Cardiac Rehabilitation Among Patients Aged 65 Years or Above[J].Curr Cardiol Rev,2017,13(4):252-262.DOI:10.2174/1574884712666170710094842.
[41]张抒扬.从我国心脏康复实践看专业心脏康复的发展方向[J].中华心血管病杂志,2016,44(1):3-4.DOI:10.3760/cma.j.issn.0253-3758.2016.01.002.
[2]Jiang L,Krumholz HM,Li X,et al.Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system[J].Lancet,2015,386(10002):1493-1505.DOI:10.1016/S0140-6736(15)00343-8.
[3]Powell R,Mc Gregor G,Ennis S,et al.Is exercise-based cardiac rehabilitation effective?A systematic review and meta-analysis to re-examine the evidence[J].BMJ Open,2018,8(3):e019656.DOI:10.1136/bmjopen-2017-019656.
[4]Anderson L,Oldridge N,Thompson DR,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.
[5]Turk-Adawi K,Sarrafzadegan N,Grace SL.Global availability of cardiac rehabilitation[J].Nat Rev Cardiol,2014,11(10):586-596.DOI:10.1038/nrcardio.2014.98.
[6]Huang K,Liu W,He D,et al.Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease:Asystematic review and meta-analysis[J].Eur J Prev Cardiol,2015,22(8):959-971.DOI:10.1177/2047487314561168.
[7]Vigorito C,Abreu A,Ambrosetti M,et al.Frailty and cardiac rehabilitation:A call to action from the EAPC Cardiac Rehabilitation Section[J].Eur J Prev Cardiol,2017,24(6):577-590.DOI:10.1177/2047487316682579.
[8]van Dam van Isselt EF,van Wijngaarden J,DJA L,et al.Geriatric rehabilitation in older patients with cardiovascular disease:a feasibility study[J].Eur Geriatr Med,2018,9(6):853-861.DOI:10.1007/s41999-018-0119-2.
[9]Cao RY,Zheng H,Mi Q,et al.Aerobic exercise-based cardiac rehabilitation in Chinese patients with coronary heart disease:study protocol for a pilot randomized controlled trial[J].Trials,2018,19(1):363.DOI:10.1186/s13063-018-2771-8.
[10]Hansen D,Stevens A,Eijnde BO,et al.Endurance exercise intensity determination in the rehabilitation of coronary artery disease patients:a critical re-appraisal of current evidence[J].Sports Med,2012,42(1):11-30.DOI:10.2165/11595460-000000000-00000.
[11]中华医学会老年医学分会75岁及以上稳定性冠心病患者运动康复中国专家共识写作组.75岁及以上稳定性冠心病患者运动康复中国家共识[J].中华老年医学杂志,2017,36(6):599-607.DOI:10.3760/cma.j.issn.0254-9026.2017.06.001.
[12]American Association of Cardiovascular and Pulmonary Rehabilitation.Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs[M].5th ed.Champaign,IL:Human Kinetics,2013:1730.
[13]Piepoli MF,CorràU,Benzer W,et al.Secondary prevention through cardiac rehabilitation:from knowledge to implementation.A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation[J].Eur J Cardiovasc Prev Rehabil,2010,17(1):1-17.DOI:10.1097/HJR.0b013e3283313592.
[14]Turk-Adawi KI,Terzic C,Bjarnason-Wehrens B,et al.Cardiac rehabilitation in Canada and Arab countries:comparing availability and program characteristics[J].BMC Health Serv Res,2015,15:521.DOI:10.1186/s12913-015-1183-7.
[15]Woodruffe S,Neubeck L,Clark RA,et al.Australian Cardiovascular Health and Rehabilitation Association(ACRA)core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014[J].Heart Lung Circ,2015,24(5):430-441.DOI:10.1016/j.hlc.2014.12.008.
[16]JCS Joint Working Group.Guidelines for rehabilitation in patients with cardiovascular disease(JCS 2012)[J].Circ J,2014,78(8):2022-2093.
[17]Milanovic'Z,SporisˇG,Weston M.Effectiveness of High-Intensity Interval Training(HIT)and Continuous Endurance Training for VO2max Improvements:A Systematic Review and Meta-Analysis of Controlled Trials[J].Sports Med,2015,45(10):1469-1481.DOI:10.1007/s40279-015-0365-0.
[18]Liou K,Ho S,Fildes J,et al.High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease:A Meta-analysis of Physiological and Clinical Parameters[J].Heart Lung Circ,2016,25(2):166-174.DOI:10.1016/j.hlc.2015.06.828.
[19]Pavy B,Iliou MC,Vergès-Patois B,et al.French Society of Cardiology guidelines for cardiac rehabilitation in adults[J].Arch Cardiovasc Dis,2012,105(5):309-328.DOI:10.1016/j.acvd.2012.01.010.
[20]Mc Gregor G,Nichols S,Hamborg T,et al.High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes(HIIT or MISS UK):study protocol for a multicentre randomised controlled trial and economic evaluation[J].BMJ Open,2016,6(11):e012843.DOI:10.1136/bmjopen-2016-012843.
[21]Williams MA,Maresh CM,Esterbrooks DJ,et al.Early exercise training in patients older than age 65 years compared with that in younger patients after acute myocardial infarction or coronary artery bypass grafting[J].Am J Cardiol,1985,55(4):263-266.
[22]Lavie CJ,Milani RV,Littman AB.Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly[J].J Am Coll Cardiol,1993,22(3):678-683.
[23]Menezes AR,Lavie CJ,Milani RV,et al.Cardiac rehabilitation and exercise therapy in the elderly:Should we invest in the aged?[J].J Geriatr Cardiol,2012,9(1):68-75.DOI:10.3724/SP.J.1263.2012.00068.
[24]Suaya JA,Stason WB,Ades PA,et al.Cardiac rehabilitation and survival in older coronary patients[J].J Am Coll Cardiol,2009,54(1):25-33.DOI:10.1016/j.jacc.2009.01.078.
[25]Doll JA,Hellkamp A,Thomas L,et al.Effectiveness of cardiac rehabilitation among older patients after acute myocardial infarction[J].Am Heart J,2015,170(5):855-864.DOI:10.1016/j.ahj.2015.08.001.
[26]Flint K,Kennedy K,Arnold SV,et al.Slow Gait Speed and Cardiac Rehabilitation Participation in Older Adults After Acute Myocardial Infarction[J].J Am Heart Assoc,2018,7(5).pii:e008296.DOI:10.1161/JAHA.117.008296.
[27]Lawler PR,Filion KB,Eisenberg MJ.Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction:a systematic review and meta-analysis of randomized controlled trials[J].Am Heart J,2011,162(4):571-584.e2.DOI:10.1016/j.ahj.2011.07.017.
[28]Taylor RS,Brown A,Ebrahim S,et al.Exercise-based rehabilitation for patients with coronary heart disease:systematic review and meta-analysis of randomized controlled trials[J].Am J Med,2004,116(10):682-692.DOI:10.1016/j.amjmed.2004.01.009.
[29]孙佩伟,李运田,宋成运,等.运动康复对老年稳定性冠心病患者危险因素的长期随访研究[J].中华老年心脑血管病杂志,2016,18(5):491-495.DOI:10.3969/j.issn.1009-0126.2016.05.013.
[30]van Halewijn G,Deckers J,Tay HY,et al.Lessons from contemporary trials of cardiovascular prevention and rehabilitation:A systematic review and meta-analysis[J].Int J Cardiol,2017,232:294-303.DOI:10.1016/j.ijcard.2016.12.125.
[31]Roohafza H,Sadeghi M,Khani A,et al.Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses[J].Int J Nurs Pract,2015,21(2):214-220.DOI:10.1111/ijn.12234.
[32]徐维芳,陈柄泉,彭智勇,等.综合医院心血管内科门诊患者失眠症发生率及其影响因素[J].中国医师杂志,2018,20(1):96-99.DOI:10.3760/cma.j.issn.1008-1372.2018.01.024.
[33]Meyer FA,Hugentobler E,Stauber S,et al.Depressive symptoms at discharge from rehabilitation predict future cardiovascular-related hospitalizations[J].Cardiology,2015,131(2):80-85.DOI:10.1159/000375231.
[34]Turk-Adawi K,Sarrafzadegan N,Grace SL.Global availability of cardiac rehabilitation[J].Nat Rev Cardiol,2014,11(10):586-596.DOI:10.1038/nrcardio.2014.98.
[35]Bjarnason-Wehrens B,Mc Gee H,Zwisler AD,et al.Cardiac rehabilitation in Europe:results from the European Cardiac Rehabilitation Inventory Survey[J].Eur J Cardiovasc Prev Rehabil,2010,17(4):410-418.DOI:10.1097/HJR.0b013e328334f42d.
[36]Anchique SCV,Lopez-Jimenez F,Benaim B,et al.Cardiac rehabilitation in Latin America[J].Prog Cardiovasc Dis,2014,57(3):268-275.DOI:10.1016/j.pcad.2014.09.006.
[37]Lawler PR,Filion KB,Eisenberg MJ.Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction:a systematic review and meta-analysis of randomized controlled trials[J].Am Heart J,2011,162(4):571-584.e2.DOI:10.1016/j.ahj.2011.07.017.
[38]Dalal HM,Doherty P,Taylor RS.Cardiac rehabilitation[J].BMJ,2015,351:h5000.DOI:10.1136/bmj.h5000.
[39]Barber K,Stommel M,Kroll J,et al.Cardiac rehabilitation for community-based patients with myocardial infarction:factors predicting discharge recommendation and participation[J].J Clin Epidemiol,2001,54(10):1025-1030.
[40]Matata BM,Williamson SA.A Review of Interventions to Improve Enrolment and Adherence to Cardiac Rehabilitation Among Patients Aged 65 Years or Above[J].Curr Cardiol Rev,2017,13(4):252-262.DOI:10.2174/1574884712666170710094842.
[41]张抒扬.从我国心脏康复实践看专业心脏康复的发展方向[J].中华心血管病杂志,2016,44(1):3-4.DOI:10.3760/cma.j.issn.0253-3758.2016.01.002.