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心脏康复和心血管疾病的二级预防：是时候考虑心血管健康而不是康复了

Cardiac rehabilitation and secondary prevention of CVD: time to think about cardiovascular health rather than rehabilitation

Nature 等信源发布 2024-09-30 03:26

可切换为仅中文

AbstractDuring the past century, there have been major developments in the medical and surgical treatment of cardiovascular disease (CVD). These advancements have resulted in more people surviving initial events and having reduced length of stay in hospital; consequently, there is an increasing number of people in need of ongoing and lifelong cardiovascular risk management.

摘要在过去的一个世纪中，心血管疾病（CVD）的内科和外科治疗取得了重大进展。这些进步导致更多的人在最初的事件中幸存下来，并缩短了住院时间；因此，越来越多的人需要持续和终身的心血管风险管理。

The physical and emotional effects of living with CVD are ongoing with broad challenges ranging from the individual to system level. However, post-discharge care of people with coronary disease continues to follow a 50-year-old cardiac rehabilitation model which focuses on the sub-acute phase and is of a finite in duration.

心血管疾病对身体和情绪的影响正在持续，从个人到系统层面都面临着广泛的挑战。然而，冠心病患者的出院后护理继续遵循50年前的心脏康复模型，该模型侧重于亚急性期，持续时间有限。

The aim of this paper is to consider the concept of supporting survivors to live well with CVD rather than ‘rehabilitating’ them and propose factors for consideration in reframing secondary prevention towards optimizing cardiovascular health. We discuss deeply-held potential considerations and challenges associated with the concept of supporting survivors achieve optimal cardiovascular health and live well with CVD rather than ‘rehabilitating’ them.

本文的目的是考虑支持幸存者更好地生活在心血管疾病中而不是“康复”他们的概念，并提出重新构建二级预防以优化心血管健康的考虑因素。我们讨论了与支持幸存者实现最佳心血管健康并与心血管疾病一起生活而不是“康复”他们的概念相关的根深蒂固的潜在考虑和挑战。

We propose the concept of 5 x P’s for reframing traditional cardiac rehabilitation towards the concept of cardiovascular health for survivors beyond ‘rehabilitation’. These include the need for personalization, processes, patient-centered care, parlance, and partnership. Taken together, consideration of challenges at the systems and population level will ultimately improve engagement with secondary prevention as well as outcomes for all people who need it..

我们提出了5 x P的概念，将传统的心脏康复改造为“康复”以外的幸存者心血管健康的概念。这些包括个性化、流程、以患者为中心的护理、用语和伙伴关系的需要。综上所述，考虑系统和人口层面的挑战将最终改善二级预防的参与程度，并为所有需要的人取得成果。。

IntroductionCardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, relentlessly continues to be the greatest cause of mortality and disease burden across the globe1. Based on 2019 data, approximately one-third of global fatalities were attributable to CVD, which equates to almost 18 million deaths1.

引言心血管疾病（CVD），包括冠心病（CHD）和中风，仍然是全球死亡率和疾病负担的最大原因1。。

Importantly, among survivors of an acute coronary event, one in four experience at least one emergency hospital admission for CVD within 2 years2. Moreover, evidence recently showed that leading CVD risk factors significantly increased the risk of poor outcomes in those infected with coronavirus disease 2019 (COVID-19)3.

重要的是，在急性冠状动脉事件的幸存者中，四分之一的人在2年内至少有一次因心血管疾病急诊入院2。此外，最近的证据表明，主要的心血管疾病危险因素显着增加了2019年冠状病毒病（COVID-19）感染者预后不良的风险3。

In this context, the global CVD crisis that has persisted for decades has decreased human resiliency in the face of other health challenges, such as viral pandemics.During the past century, there have been major developments in CVD management in terms of how a diagnosis is made, how arteries are revascularized, particularly in coronary vasculature, and the breadth and effectiveness of available medications for people with CVD4.

在这种情况下，持续数十年的全球心血管疾病危机降低了人类面对其他健康挑战（如病毒性大流行）的弹性。在过去的一个世纪中，心血管疾病管理在诊断方式，动脉血运重建（尤其是冠状动脉血管系统）以及CVD4患者可用药物的广度和有效性方面取得了重大进展。

These advancements have resulted in more people surviving initial events and having reduced length of stay in hospital3; consequently, there is an increasing number of people in need of ongoing and lifelong cardiovascular risk management5. As such, international groups and organizations have identified improved secondary prevention as an global priority6,7.

这些进步导致更多的人在最初的事件中幸存下来，并缩短了住院时间3；因此，越来越多的人需要持续和终身的心血管风险管理5。因此，国际团体和组织已将改进二级预防确定为全球优先事项6,7。

In addition, the impact of receiving a diagnosis of CVD or surviving a heart attack is traumatic and life-changing8. The physical and emotional effects of living with CVD9 are ongoing with broad challenges ranging from the individual to system level10.Global health systems are facing an escalating challenge.

此外，接受CVD诊断或在心脏病发作中幸存下来的影响是创伤性的和改变生命的8。。

The combination of an aging population and decre.

人口老龄化与人口减少的结合。

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Download referencesAcknowledgementsJ.R. is funded by a National Health and Medical Research Council (NHMRC) Investigator Grant (GNT2007946). A.O. is supported by an NHMRC Emerging Leader 2 Fellowship (2009295). K.H. and E.T. are supported by NHMRC Emerging Leader Fellowships (GNT1196724 and GNT2017450, respectively).

下载referencesAcknowledgementsJ。R、 由国家卫生与医学研究委员会（NHMRC）研究人员资助（GNT2007946）。A、 O.得到了NHMRC新兴领导者2奖学金（2009295）的支持。K、 H.和E.T.得到了NHMRC新兴领导者奖学金（分别为GNT1196724和GNT2017450）的支持。

S.G., M.H., G.C. and L.Z. are funded by NHMRC Synergy Grant SOLVE-CHD postdoctoral fellowships (APP1182301). I.G. is funded through a Health Research Board Ireland Collaborative Doctoral Award 2019 (CDA-2019-001). R.S.T. has led and received research funding for trials of CR past and present and is currently Director of Cochrane cardiac rehabilitation review programme.

S、 G.，M.H.，G.C.和L.Z.由NHMRC Synergy Grant SOLVE-CHD博士后奖学金（APP1182301）资助。一、 G.由2019年爱尔兰卫生研究委员会合作博士奖（CDA-2019-001）资助。R、 S.T.领导并获得了过去和现在CR试验的研究资金，目前是Cochrane心脏康复评估计划的主任。

No funding organisation had a role in the content or preparation of the manuscript.Author informationAuthors and AffiliationsInstitute for Evidence-Based Healthcare, Bond University, Gold Coast, NSW, AustraliaJulie RedfernSusan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, AustraliaJulie Redfern, Robyn Gallagher, Dion Candelaria, Georgia K.

没有任何资助组织在稿件的内容或准备中发挥作用。作者信息作者和附属机构新南威尔士州黄金海岸邦德大学循证医疗保健研究所，澳大利亚新南威尔士州悉尼大学医学与健康学院护理与助产学院，澳大利亚新南威尔士州悉尼，澳大利亚朱利·雷德芬，罗宾·加拉赫，乔治亚州迪翁·坎德拉里亚。

Chaseling & Ling ZhangCurtin School of Allied Health, Curtin University, Bentley, WA, AustraliaAndrew MaioranaAllied Health Department, Fiona Stanley Hospital, Murdoch, WA, AustraliaAndrew MaioranaSchool of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, AustraliaMatthew Hollings & Karice HyunInstitute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, AustraliaSarah Gauci & Adrienne O’NeilCentre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, AustraliaEmma E.

Chaseling&Ling ZhangCurtin联合健康学院，科廷大学，宾利，华盛顿州，澳大利亚安德烈·马约拉纳联合健康系，菲奥纳·斯坦利医院，默多克，华盛顿州，澳大利亚安德烈·马约拉纳健康科学学院，医学与健康学院，悉尼大学，悉尼，新南威尔士州，澳大利亚马修·霍林斯和卡里斯·海宁精神与身体健康与临床翻译研究所，迪肯大学，吉隆，维多利亚州，澳大利亚阿拉赫·高西和阿德里安·奥尼尔在线健康中心，昆士兰大学健康服务研究中心，布里斯班，昆士兰，昆士兰，昆士兰，昆士兰。

ThomasKite Research Institute, University Health Network, Toronto, CanadaGabriela L. M. GhisiScho.

托马斯基特研究所，大学健康网络，多伦多，加拿大。

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PubMed Google ScholarContributionsJ.R., R.G., S.L.G. conceived the manuscript. J.R., D.C., E.E.T., G.L.M.G., D.W., T.B. drafted the manuscript. J.R., A.M., M.H., S.G., A.O., I.G., A.B., R.S.T., R.A., C.J., D.W., S.L.G. contributed to development of recommendations and considerations for reframing.

PubMed谷歌学术贡献。R、 ，R.G.，S.L.G.构思了手稿。J、 R.，D.C.，E.E.T.，G.L.M.G.，D.W.，T.B.起草了手稿。J、 R.，A.M.，M.H.，S.G.，A.O.，I.G.，A.B.，R.S.T.，R.A.，C.J.，D.W.，S.L.G.为制定重构建议和考虑因素做出了贡献。

J.R., G.K.C., L.Z., K.H., C.J. contributed to literature synthesis. J.R., R.G., A.M., D.C., M.H., S.G., A.O., G.K.C., L.Z., E.E.T., G.L.M.G., I.G., K.H., A.B., T.B., R.S.T., R.A., C.J., D.W., S.L.G. (all authors) reviewed and approved the final manuscript.Corresponding authorCorrespondence to.

J、 R.，G.K.C.，L.Z.，K.H.，C.J.为文献综合做出了贡献。J、 R.，R.G.，A.M.，D.C.，M.H.，S.G.，A.O.，G.K.C.，L.Z.，E.E.T.，G.L.M.G.，I.G.，K.H.，A.B.，T.B.，R.S.T.，R.A.，C.J.，D.W.，S.L.G.（所有作者）审查并批准了最终稿件。对应作者对应。

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Reprints and permissionsAbout this articleCite this articleRedfern, J., Gallagher, R., Maiorana, A. et al. Cardiac rehabilitation and secondary prevention of CVD: time to think about cardiovascular health rather than rehabilitation.

转载和许可本文引用本文Redfern，J.，Gallagher，R.，Maiorana，A。等人。心脏康复和心血管疾病的二级预防：是时候考虑心血管健康而不是康复了。

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