Construction And Application Of Hospital-community-home Based Cardiac Rehabilitation Program For Patients With Acute Myocardial Infarction After PCI

ObjectiveThe purpose of this study is to construct a hospital-community-home based cardiac rehabilitation program,and to explore the effects of this program on the incidence of major cardiovascular events,the control of risk factors,exercise endurance,cardiac function and quality of life in patients with acute myocardial infarction after PCI,eventually providing practical guidance for patients.MethodsBy reviewing current literature,relevant guidelines and expert consensus,we formed a hospital-community-home based cardiac rehabilitation scheme for patients with acute myocardial infarction after PCI.The scheme was thoroughly discussed and revised by experts.By convenient sampling,130 patients with acute myocardial infarction who underwent PCI in Qingdao were enrolled.Among them,65 eligible patients from March2019 to May 2019 were selected as the control.In order to avoid disturbances to the control group caused by the implementation of cardiac rehabilitation program,65 patients who met the enrollment standards from May 2020 to July 2020 were selected as the intervention group after the patients in the control group recovered for one year.The patients in the control group received routine cardiac rehabilitation and completed four hospital-oriented follow-up visits after discharge.The intervention group implemented a hospital-community-home based cardiac rehabilitation program on the basis of the control group and participated in eight community-oriented follow-up visits under the guidance of the hospital.The follow-up included exercise test,nutrition consultation,risk factor control,smoking cessation supervision,medication plan,psychological adjustment and other contents.Various forms of health education were carried out simultaneously.The patients completed family rehabilitation according to the requirements of the individualized cardiac rehabilitation program.The Short Form-12 scale（SF-12）,patient health questionnaire-9 depressive symptom group scale（PHQ-9）,generalized anxiety disorder-7 scale（GAD-7）,six minute walking test and cardiopulmonary exercise test were used.Select pre intervention,six months and one year after intervention as the investigation time point to analyze the long-term intervention effect.The incidence of major cardiovascular events was taken as the main outcome index,and the clinical indexes,quality of life,psychological state,smoking cessation,cardiac rehabilitation compliance,aerobic exercise endurance and cardiopulmonary function were compared at the same time.Chi square test,t-test,rank sum test,repeated measurement analysis of variance and other statistical methods were used to analyze the data with SPSS 26.0statistical software,and evaluate the effects of hospital-community-home based cardiac rehabilitation program.Results1.There was no significant difference in general characteristics between the two groups（P>0.05）.There was no significant difference in baseline characteristics between the two groups before intervention（P>0.05）.2.One year after intervention,the incidence of major cardiovascular events in the intervention group（11.11%）was significantly lower than that in the control group（34.43%）（P<0.01）.3.Six months and one year after the intervention,the control rates of fasting blood glucose,systolic blood pressure,BMI,total cholesterol,triglyceride,low-density lipoprotein and high-density lipoprotein in the intervention group were better than those in the control group（P<0.05）.The repeated measurement ANOVA results of diastolic blood pressure in the two groups were not statistically significant（P>0.05）.4.Six months and one year after the intervention,the smoking cessation rate of the intervention group was higher than that of the control group（P<0.05）.5.Six months and one year after the intervention,the SF-12 score of quality of life between the two groups was statistically significant（F=28.683,P<0.001）;With the increase of time,there was significant difference in the scores of quality of life between the two groups（F=6.033,P<0.05）;After the intervention,the interaction effect of quality of life scores between the two groups was statistically significant（F=4.810,P<0.05）;The SF-12 scores of the intervention group at six months and one year after intervention were higher than those of the control group（P<0.001）.6.Six months and one year after the intervention,the PHQ-9 score and GAD-7 score were lower than in the control group（P<0.01）.7.One year after the intervention,the cardiac rehabilitation compliance of the intervention group was higher than that of the control group（P<0.01）.8.The overall mean difference between the two groups after the intervention of six minute walking test distance was statistically significant（F=93.420,P<0.001）;With the increase of time,the difference of six-minute walking test distance between the two groups was statistically significant（F=5.194,P<0.05）;After the intervention,the interaction effect of the comparison of six-minute walk test distance between the two groups was statistically significant（F=29.885,P<0.001）;The six-minute walking test distance of the intervention group at six months and one year after the intervention was better than that of the control group（p<0.05）,and the fatigue score was lower than that of the control group（P<0.001）.9.After the intervention,the main effects of peak oxygen uptake（peak VO₂）,anaerobic threshold（AT）,metabolic equivalent（MET）and left ventricular ejection fraction（LVEF）was statistically different（P<0.001）;With the increase of time,there was significant difference in peak VO₂,AT,MET and LVEF between the two groups（P<0.01）;The interaction effect of peak VO₂,AT,MET and LVEF in the two groups was statistically different（P<0.01）.The peak VO₂,AT,MET and LVEF in the intervention group were better than those in the control group at six months and one year after the intervention（P<0.05）.The results of repeated measurement ANOVA of left ventricular end diastolic diameter（LVEDD）were not statistically significant（P>0.05）.ConclusionsHospital-community-home based cardiac rehabilitation program is conducive to reduce the incidence of major cardiovascular events in patients with acute myocardial infarction after PCI.At the same time,it can help control the risk factors of cardiovascular disease,improve exercise ability,cardiac function,psychological state and quality of life,and improve rehabilitation compliance.The implement of this scheme can form a heart rehabilitation chain in which the hospital leads the community in prevention and treatment of diseases,improve the efficiency of community heart rehabilitation,promote the long-term effect of cardiac rehabilitation,and provide clinical guidance for patient health management.