Enhancing cardiac rehabilitation outcomes with patient models: a retrospective study

Vollständiger Abstract

Worum geht es in dieser Arbeit?

INTRODUCTION. Cardiac rehabilitation is an important part of the clinical care provided to patients with coronary heart disease. It is essential to clarify the principles governing patient referral in order to improve the effectiveness of rehabilitation programmes. AIM. To identify patient profiles that are most likely to 'respond' to stages 2 and 3 of rehabilitation treatment, drawing on the analysis of factors contributing to the effectiveness of cardiac rehabilitation. MATERIALS AND METHODS. The source of information was an online form comprising 8 sections, 134 performance indicators, which did not contain any patients' personal data. The study results were used in aggregated form; the study did not require approval from the ethics committee. In 2024, cases of patient rehabilitation following acute myocardial infarction in Sverdlovsk Region were analysed, focusing on patients who had completed stages 2nd and 3rd in 2023. The research was carried out throughout 2024 on the premises of A.B. Blokhin Ural Institute of Healthcare Management. A mathematical analysis was performed, comparing pairs of patient groups. The total sample size was 753 cases (594 in stage 2, 159 in stage 3). To assess the effectiveness, the increase in the 6-minute walk test scores and the change in functional class were used; 18 comparison groups were formed. The frequencies of characteristics in the subgroups were calculated, along with values for Pearson's χ2 test, Fisher's exact two-tailed test, and the odds ratio. To develop patient models, indicators showing statistically significant differences (p 0.01) were selected. Data processing and calculations were performed using Microsoft Office Excel-2016. RESULTS. In the subgroup of patients who responded most favourably to stage 2 of the rehabilitation programme — male patients aged under 59, diagnosed with I21.1, with an average Rivermid index (12–13 points), the best scores on the Berg scale (51–56 points), with the lowest risk of falls on the Morse scale (24 points or fewer), a low risk on the GRACE scale (1–108 points), average scores on the Borg scale (15–16 points), and high scores on the Barthel scale (91–100 points). Further consideration is required regarding the impact of patients' condition on admission, as assessed by the GRACE scale and the rehabilitation referral scale, on the success of the 3rd stage of rehabilitation. DISCUSSION. The developed models of patients who 'respond' to the stages of cardiac rehabilitation to the greatest extent and to an insufficient extent indicate the need for a comprehensive assessment using both cardiac-specific and general functional scales. CONCLUSION. When developing models of patients who are most likely to 'respond' to rehabilitation, in addition to the degree of dependency as measured on the rehabilitation referral scale, other criteria must be taken into account to ensure correct referral and to assess the effectiveness of rehabilitation for cardiac patients.