Study on influencing factors and effect evaluation of patients with acute myocardial infarction in the cardiac rehabilitation center

doi:10.3969/j.issn.1674-8115.2022.05.013

Abstract

Abstract: Objective

·To analyze the relevant influencing factors of patients with acute myocardial infarction (AMI) in the cardiac rehabilitation center (CRC), and evaluate the rehabilitation effect, in order to provide evidence for the effective development of cardiac rehabilitation.

Methods

·From May 2020 to October 2021, 454 patients with moderate and high-risk AMI who received emergency percutaneous coronary intervention in Renji Hospital, Shanghai Jiao Tong University School of Medicine were selected. Their general demographic data and disease situation were collected and analyzed. Patients were divided into two groups based on whether they chose to visit the CRC. Logistic regression model was performed to explore the relevant factors of AMI patients enrolled in CRC, and to compare the changes of cardiopulmonary function and body fat measurement of AMI patients before the first visit to CRC and after 3 months in CRC after discharge.

Results

·A total of 32 (7.05%) patients (group 1) were enrolled in CRC after discharging from ward, and the other patients (group 2) did not. The analysis of general demographic data and disease situation showed that there were significant differences in age, religious belief, educational background and working state (all P<0.05). Logistic regression analysis showed that age, educational background (high school / technical secondary school, college or above), occurrence of two cardiac vascular lesions and left ventricular ejection fraction (LVEF) before discharge were the protective factors of AMI patients enrolled in CRC, while religious belief was the risk factor (all P<0.05). Compared with the indexes before the first visit to CRC, the peak ventilation oxygen per kilogram (t=7.619, P=0.000) and ventilation oxygen in the anaerobic threshold per kilogram (t=5.510, P=0.000) of AMI patients enrolled in CRC 3 months after discharge were higher, while the body mass index (t=3.132, P=0.004) and waist hip rate (t=3.891, P=0.000) were lower.

Conclusion

·The enrolling percentage of moderate and high-risk AMI patients in CRC is still at a low level, and age, religious belief, educational background, cardiac vascular lesions and LVEF before discharge are the influencing factors. Patients enrolling in CRC 3 months later have significant improvement in cardiopulmonary function and body fat.

Key words: acute myocardial infarction (AMI), cardiac rehabilitation center (CRC), cardiac rehabilitation, influencing factor, effect

CLC Number:

R473.5

XU Li, YANG Yan, CHEN Hanfen, JIANG Meng, PU Jun. Study on influencing factors and effect evaluation of patients with acute myocardial infarction in the cardiac rehabilitation center[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 646-652.

Figures/Tables 4

TrendMD

References 29

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Item	Total （n=454）	Group 1（n=32）	Group 2 （n=422）	t/χ² value	P value
General demographic data
Age/year	60.10±10.57	53.75±13.08	60.57±10.20	2.884	0.007
Gender/n（%）				0.062	0.803
Male	398 （87.7）	29 （90.6）	369 （87.4）
Female	56 （12.3）	3 （9.4）	53 （12.6）
Marriage/n（%）				0.000	1.000
Married	435 （95.8）	31 （96.9）	404 （95.7）
Unmarried/divorced/widowed	19 （4.2）	1 （3.1）	18 （4.3）
Religious belief/n（%）				4.230	0.040
No	443 （97.6）	29 （90.6）	414 （98.1）
Yes	11 （2.4）	3 （9.4）	8 （1.9）
Education background/n（%）				22.761	0.000
Middle school or below	198 （43.6）	5 （15.6）	193 （45.7）
High school/technical secondary school	133 （29.3）	7 （21.9）	126 （29.9）
College or above	123 （27.1）	20 （62.5）	103 （24.4）
Working state/n（%）				13.403	0.000
In-service	139 （30.6）	19（59.4）	120 （28.4）
Retired/unemployed	315 （69.4）	13（40.6）	302 （71.6）
Type of medical expenses paid/n（%）				0.140	0.708
Health insurance	357 （78.6）	26 （81.3）	331 （78.4）
Self-paying	97 （21.4）	6 （18.8）	91 （21.6）
Disease situation
Number of cardiac vascular lesions/n（%）				7.560	0.056
1	101 （22.2）	7 （21.9）	94 （22.3）
2	127 （28.0）	13 （40.6）	114 （27.0）
3	189 （41.6）	7 （21.9）	182 （43.1）
>3	37 （8.1）	5 （15.6）	32 （7.6）
Number of days in CCU/d	6.07±3.75	6.50±3.60	6.04±3.77	0.671	0.503
NT-proBNP at discharge/n（%）				0.589	0.745
<300 pg·mL^-1	39 （8.6）	3 （9.4）	36 （8.5）
300 pg·mL^-1 ‒900 pg·mL^-1	201 （44.3）	16 （50.0）	185 （43.8）
>900 pg·mL^-1	214 （47.1）	13 （40.6）	201 （47.6）
LVEF at discharge/%	53.47±8.36	50.91±7.53	53.29±8.39	1.561	0.119
HbA1c at admission/%	6.43±1.54	6.47±1.96	6.43±1.51	0.140	0.889
TC at admission/（mmol·L^-1）	4.63±1.09	4.89±1.25	4.61±1.08	1.391	0.165
LDL-C at admission/（mmol·L^-1）	2.87±0.91	3.05±0.91	2.85±0.91	1.180	0.238

Item	Total （n=454）	Group 1（n=32）	Group 2 （n=422）	t/χ² value	P value
General demographic data
Age/year	60.10±10.57	53.75±13.08	60.57±10.20	2.884	0.007
Gender/n（%）				0.062	0.803
Male	398 （87.7）	29 （90.6）	369 （87.4）
Female	56 （12.3）	3 （9.4）	53 （12.6）
Marriage/n（%）				0.000	1.000
Married	435 （95.8）	31 （96.9）	404 （95.7）
Unmarried/divorced/widowed	19 （4.2）	1 （3.1）	18 （4.3）
Religious belief/n（%）				4.230	0.040
No	443 （97.6）	29 （90.6）	414 （98.1）
Yes	11 （2.4）	3 （9.4）	8 （1.9）
Education background/n（%）				22.761	0.000
Middle school or below	198 （43.6）	5 （15.6）	193 （45.7）
High school/technical secondary school	133 （29.3）	7 （21.9）	126 （29.9）
College or above	123 （27.1）	20 （62.5）	103 （24.4）
Working state/n（%）				13.403	0.000
In-service	139 （30.6）	19（59.4）	120 （28.4）
Retired/unemployed	315 （69.4）	13（40.6）	302 （71.6）
Type of medical expenses paid/n（%）				0.140	0.708
Health insurance	357 （78.6）	26 （81.3）	331 （78.4）
Self-paying	97 （21.4）	6 （18.8）	91 （21.6）
Disease situation
Number of cardiac vascular lesions/n（%）				7.560	0.056
1	101 （22.2）	7 （21.9）	94 （22.3）
2	127 （28.0）	13 （40.6）	114 （27.0）
3	189 （41.6）	7 （21.9）	182 （43.1）
>3	37 （8.1）	5 （15.6）	32 （7.6）
Number of days in CCU/d	6.07±3.75	6.50±3.60	6.04±3.77	0.671	0.503
NT-proBNP at discharge/n（%）				0.589	0.745
<300 pg·mL^-1	39 （8.6）	3 （9.4）	36 （8.5）
300 pg·mL^-1 ‒900 pg·mL^-1	201 （44.3）	16 （50.0）	185 （43.8）
>900 pg·mL^-1	214 （47.1）	13 （40.6）	201 （47.6）
LVEF at discharge/%	53.47±8.36	50.91±7.53	53.29±8.39	1.561	0.119
HbA1c at admission/%	6.43±1.54	6.47±1.96	6.43±1.51	0.140	0.889
TC at admission/（mmol·L^-1）	4.63±1.09	4.89±1.25	4.61±1.08	1.391	0.165
LDL-C at admission/（mmol·L^-1）	2.87±0.91	3.05±0.91	2.85±0.91	1.180	0.238

Factor	Variable	Assignment
Age	X₁	Actual value
Gender	X₂	Male=0； Female=1
Marriage	X₃	Married=0； Unmarried/divorced/widowed=1
Religious belief	X₄	No=0； Yes=1
Education background	X₅	Middle school or below=0； High school/ technical secondary school=1； College or above=2
Working state	X₆	In-service=0； Retired/unemployed=1
Type of medical expenses paid	X₇	Health insurance=0； Self-paying=1
Number of cardiac vascular lesions	X₈	1=0； 2=1； 3=2； >3=3
Number of days in CCU	X₉	Actual value
NT-proBNP at discharge	X₁₀	<300 （pg·mL^-1） =0； 300 （pg·mL^-1）－900 （pg·mL^-1） =1； >900 （pg·mL^-1） =2
LVEF at discharge	X₁₁	Actual value
HbA1c at admission	X₁₂	Actual value
TC at admission	X₁₃	Actual value
LDL-C at admission	X₁₄	Actual value
Enrolled in CRC	Y	No=0； Yes=1

Factor	Variable	Assignment
Age	X₁	Actual value
Gender	X₂	Male=0； Female=1
Marriage	X₃	Married=0； Unmarried/divorced/widowed=1
Religious belief	X₄	No=0； Yes=1
Education background	X₅	Middle school or below=0； High school/ technical secondary school=1； College or above=2
Working state	X₆	In-service=0； Retired/unemployed=1
Type of medical expenses paid	X₇	Health insurance=0； Self-paying=1
Number of cardiac vascular lesions	X₈	1=0； 2=1； 3=2； >3=3
Number of days in CCU	X₉	Actual value
NT-proBNP at discharge	X₁₀	<300 （pg·mL^-1） =0； 300 （pg·mL^-1）－900 （pg·mL^-1） =1； >900 （pg·mL^-1） =2
LVEF at discharge	X₁₁	Actual value
HbA1c at admission	X₁₂	Actual value
TC at admission	X₁₃	Actual value
LDL-C at admission	X₁₄	Actual value
Enrolled in CRC	Y	No=0； Yes=1

Independent variable	OR	95%CI	P value
Age	0.953	0.909‒1.000	0.048
Religious belief
No	1	‒	‒
Yes	15.803	2.971‒84.055	0.001
Education background
Middle school or below	1	‒	‒
High school/ technical secondary school	0.220	0.059‒0.822	0.024
College or above	0.171	0.038‒0.768	0.021
Number of cardiac vascular lesions
1	1	‒	‒
2	0.089	0.013‒0.604	0.013
3	0.509	0.125‒2.062	0.344
>3	0.239	0.057‒1.005	0.051
LVEF at discharge	0.925	0.874‒0.980	0.008
Constant	223.858	‒	0.010