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急性心肌梗死患者心脏康复依从性的影响因素分析

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目的 探讨急性心肌梗死(AMI)患者心脏康复依从性的影响因素.方法 选取2020年1月至2022年12月浙江省金华市中心医院收治的428例AMI患者作为训练集,根据依从性将其分为依从性良好组(225例)和依从性不良组(203例).分析AMI患者心脏康复依从性的影响因素,基于回归分析结果构建预测模型,绘制该模型预测AMI患者心脏康复依从性的受试者操作特征曲线.再以同期收治的72例AMI患者作为验证集进行外部验证.结果 依从性良好组与依从性不良组年龄、居住地、文化程度、血运重建方式、月收入水平、家庭支持度和医护人员督促比较,差异有统计学意义(P<0.05).logistic回归分析显示,居住地为农村(OR=1.853)、文化程度高中及以下(OR=2.481)、月收入水平≤5 000元(OR=3.105)、家庭支持度较差(OR=2.695)和无医护人员督促(OR=2.171)是AMI患者心脏康复依从性不良的独立危险因素(P<0.05).将居住地的标准化β值赋分为1分,经处理后得到各因素权重对应的整数值.其中0分患者未出现依从性不良情况,7分患者依从性不良发生率高达96.00%.训练集预测AMI患者心脏康复依从性的曲线下面积为0.876(95%CI:0.731~0.925),验证集为0.893(95%CI:0.755~0.967).训练集与验证集预测曲线与标准曲线较为吻合;当模型预测概率阈值在0.16~0.84时,实施干预获得的临床获益最高.结论 AMI患者心脏康复依从性主要受居住地、文化程度、家庭支持度、月收入水平和医护人员督促情况等影响.基于多因素logistic回归分析构建预测模型可有效预测AMI患者依从性.
Analysis of influencing factors on cardiac rehabilitation compliance in patients with acute myocardial infarction
Objective To explore influencing factors of cardiac rehabilitation compliance in patients with acute myocardial infarction(AMI).Methods A total of 428 patients with AMI admitted to Jinhua Municipal Central Hospital of Zhejiang Province from January 2020 to December 2022 were selected as the training set,and they were divided into the good compliance group(225 cases)and the poor compliance group(203 cases)based on compliance status.The influencing factors affecting the cardiac rehabilitation compliance in patients with AMI were analyzed,prediction model was constructed based on regression analysis results,and receiver operator characteristic curve of cardiac rehabilitation compliance in patients with AMI was plotted by drawing the model.External validation was conducted by using 72 AMI patients admitted at the same period as the validation set.Results There were statistically significant differences in age,residence,education level,blood flow reconstruction methods,monthly income level,family support,and medical staff supervision between the good compliance group and the poor compliance group(P<0.05).Logistic regression analysis showed that residence in rural areas(OR=1.853),education level high school or below(O R=2.481),monthly income level≤ 5 000 yuan(OR=3.105),poor family support(OR=2.695),and no medical staff supervision(OR=2.171)were independent risk factors for poor cardiac rehabilitation compliance in patients with AMI(P<0.05).The standardized β value of residence was divided into one point,and the integer value corresponding to the weight of each factor was obtained after processing.Patients with score of zero did not experience any compliance issues,while patients with score of seven had incidence rate of compliance issues of 96.00%.The area under curve of the training set model for predicting cardiac rehabilitation compliance in patients with AMI was 0.876(95%CI:0.731-0.925),and the validation set was 0.893(95%CI:0.755-0.967).The prediction curve of training set and verification set was in good agreement with the standard curve;when the model predicted probability threshold was 0.16-0.84,the clinical benefit of the intervention was the highest.Conclusion The cardiac rehabilitation compliance in patients with AMI is mainly influenced by factors such as residence,educational level,family support,monthly income level,and supervision by medical staff.Constructing a predictive model based on multivariate logistic regression analysis can effectively predict poor compliance in patients with AMI.

Acute myocardial infarctionCardiac rehabilitationInfluencing factorsPrediction modelCompliance

黄春艳、吴丹丹、汪晓敏

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浙江省金华市中心医院,浙江金华 321000

急性心肌梗死 心脏康复 影响因素 预测模型 依从性

浙江省医药卫生科技计划项目

2024KY1748

2024

中国医药导报
中国医学科学院

中国医药导报

CSTPCD
影响因子:1.759
ISSN:1673-7210
年,卷(期):2024.21(18)
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