Contemporary trends in cardiac rehabilitation in Germany: patient characteristics, drug treatment, and risk-factor management from 2000 to 2005.

摘要

BACKGROUND: Cardiac rehabilitation (CR) has a pivotal role in the management of patients with coronary heart disease. We aimed to describe temporal trends and centre variances of patient characteristics, drug prescriptions, and risk-factor management of in-patients in inpatient CR in Germany. METHODS: Data on 117 983 inpatients in CR, obtained from two large-scale registries (Transparency Registry to Objectify Guideline-Oriented Risk-Factor Management and Registry of Guidelines) were pooled resulting in a database of six yearly cross-sectional samples, repeated over centres. For each response variable, a three-level mixed model (patients within years within centres) shifted to the data. Statistical tests were performed on average time trends over groups, average group levels over years, and on parallelism of trends within groups. RESULTS: Compared with patients in CR in 2000, patients in CR in 2005 were significantly older and had a higher BMI. They, however, also showed improved control over blood pressure, lipids, and glucose at the beginning of rehabilitation; their use of angiotensin-converting enzyme inhibitors and beta-blockers had increased; whereas their use of statin and acetylsalicylic acid remained relatively stable. At discharge, no changes were noted for blood pressure and glucose - at a high target-level attainment of more than 80%. Lipid values, however, tended to improve over time, with an increase in target-level attainment from 45 to 55%. Large centre effects were noted for age, total cholesterol at entry, and exercise capacity at entry and discharge. In general, sex differences were limited. DISCUSSION: Compared with previous findings, general management of risk factors before initiation of CR, as well as control over lipid, hypertension, and glucose levels at discharge from CR, have improved over time: this is probably due to more intensive drug treatment.