| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 102 === The treatment of acute myocardial infarction (AMI) in modern medicine is changing rapidly, and remarkable progress has been made with regard to basic medicines, catheter treatments, and coronary artery bypass graft surgery requiring thoracotomy. Whether it is the development of a new generation of drugs or the use of drug-eluting stents, the treatment for diseases has been completely transformed and cannot be fully described. However, the cardiopulmonary depression caused by AMI remains reliant on cardiac rehabilitation to enhance recovery. Many of the complications associated with myocardial infarction also endanger patient health, not only increasing the number of hospitalization days but also increasing the consumption of medical resources and medical expenses. This study investigated whether the occurrence of these complications were affected after patients received cardiac rehabilitation; moreover, it explored the effect that other factors had on these complications. Using the 1997-2010 National Health Insurance (NHI) Research Database of the millions of people this organization sampled, the data of patients with a first occurrence of AMI from 2000 to 2005 were examined. First, a group-based trajectory model (GBTM) was used to analyze the frequency of the complications that occurred within 1 year after onset among these patients. Furthermore, the patients were divided into 3 groups for the sake of discussion. Three months were considered an observational period, and observations were collected at different time points for the same patients. Trends over time were analyzed using generalized estimating equations based on different control variables, and the adjusted odds ratio for each variable was calculated. The results showed that fewer complications occurred among patients who received rehabilitation (adjusted odds ratio = 0.90). Two groups of moderate and high occurrence maintained higher rates of complications (adjusted odds ratio = 3.07 and 6.25, respectively). However, the frequency of complications slightly increased with age (adjusted odds ratio = 1.01). In terms of comorbidities, the complication rates increased (adjusted odds ratio = 1.04) or decreased (adjusted odds ratio = 0.95) among patients with congestive heart failure (CHF) or peripheral vascular disease (PVD), respectively. The other comorbidities did not significantly affect the frequency of complications.
Conclusions: Patients undergoing cardiac rehabilitation can reduce the occurrence of complications (i.e., the number of hospitalizations and the length of stay). Furthermore, their medical expenses can be reduced. Because cardiac rehabilitation is not popular, most patients are not benefited; therefore, cardiac rehabilitation should be promoted across disciplines to establish appropriate knowledge, cooperate with secondary prevention, adjust patient lifestyles, and allow patients to return to a healthy life.
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