| BackgroundNowadays,acute coronary syndrome(ACS)is one of the main causes of death worldwide.ACS patients have been treated timely and effectively with the advanced medical technology extensively processing.However the medical workers and the patients seldom paid attention to the prevention and rehabilitation which would enhance the recurrences,the exacerbations and even sudden death in ACS patients.Cardiac rehabilitation(CR)refers to the application of a variety of collaborative,purposeful intervention measures,including rehabilitation assessment,movement training,guidance of eating habits,regular medication,regular monitoring of the prognostic indicators and accepted health education,etc..It can help the ACS patients to improve the quality of life,return to normal social life,to prevent the cardiovascular events.Obesity is recognized as an independent risk factor for ACS and it is closely related to processing heart failure,cardiovascular events on ACS and the risk of death and so on.Along with unceasing enhancement of the material life level,the popular trend of obesity has formed the internationalization and the obesity rates around the world shows only increasing.Relevant data indicates that,more than 80%of the global ACS patients suffer from obesity.Moreover,the annual statistics on the year of 1996-2006 shows that,more than 80%of patients with CR are overweight,and more than 44%are obese.Research is increasingly showing that CR plays a key role on reducing mortality and prognostic on patients with ACS.It also has been in the global multinational development,on the world emphasis and advancing perfectly.One of the most important purposes of CR after ACS is the effective management of obese people;they reduce the morbidity and mortality of cardiovascular events.It is imminent to implement obesity management effectively in CR and to make benefit on the patients with ACS especially obesity.But in clinical work,we need to use the obesity evaluation indicators to estimate the effect of obesity management,make the preliminary assessment of the prognosis of patients with CR.Common clinical obesity evaluation indexes including body mass index(BMI)and waist circumference(WC).BMI has been a well-accepted index to evaluate the overweight or obese individuals and predicted mortality in patients with ACS previously.But Gruberg et al.has found the obesity paradox phenomenon,which is reported that BMI fails to reflect true body composition and obese patients seems to survive better in ACS populations.In the contrast,WC can better reflect an increased risk of mortality in patients with ACS.Furthermore it can counteract the induced theory of’obesity paradox’ with BMI.Therefore,as indicators of obesity,it is unreported on the references that which one has better maneuverability by comparison between BMI and WC,and which one can better reflect the actual effect of rehabilitation and the prognosis of the damage on the target organ on the CR patients after ACS.Moreover,nowadays CR has the characteristics of complex process,low technological content,narrow application level,slow operation movement,inferior effect and low participation rate on multifarious and traditional mode of the clinical procedure.To do better to the implementation of a series of treatment to control weight,the regulation of lipid and rehabilitation training of CR,the realization of real-time management of CR program is adjusted at any time according to the change of objective indexes,therefore,it also unreported that can we apply the forthright,efficient and networked mode on the management of CR to replace the complex,inefficient and usual follow-up procedure on the management of CR.PurposeOur study has two main research purpose:1.It is mainly about the follow-up and analysis for WC,BMI and obesity management prognostic parameters of CR after ACS.In order to estimate the relevance and effectiveness of assessing the measurement and evaluation of the WC,BMI on CR patients after ACS with obesity management on prognostic indicators such as organ damage,etc.2.It is also about the improvement on the exercise function,completion rate and the standardize management of obesity through the implement of young and middle-aged patients with comprehensive and intelligence network measurement mode on the CR.ObjectThe study was conducted in the General Hospital of Guangzhou Military Command of People’ s Liberation Army(PLA),Guangdong Province,China.130 patients between October 2013 and January 2014 after percutaneous coronary intervention(PCI)or thrombolytic therapies were recruited to our study.We classified the patients into experimental group and control group equally using a randomized,double blind method,65 cases in each groups.The experimental group implemented CR with intelligent network management mode,the control group adopted conventional treatment mode.After finishing the follow-up,the experimental group was lost 4 cases and the control group was lost 12 cases.114 total cases completed our study with the elimination of lost cases,including 61 cases in the experimental group and 53 cases in the control group.The subjects in this study fulfilled the following inclusion criteria:(1)aged 18-60 years,(2)established ACS,(3)suitable for the CRP,(4)no weight reduction drug treatment or surgery before participating this study,and(5)the existence of coronary artery lesions confirmed by coronary angiography(CAG)at the entry.The subjects in this study also fulfilled the following exclusion criteria:(1)severe complications of acute myocardial infarction(AMI),(2)any contradiction of exercise,(3)uncontrolled malignant arrhythmia,(4)severe aortic stenosis,(5)acute congestive heart failure decomposition,(6)uncontrolled diabetes mellitus(DM)and hypertention(HT),(7)severe acute pericarditis and myocarditis,(8)recent thrombosis and thrombophlebitis,(9)other metabolic disorders such as:actue thytoiditis,hyperkalemia and hypokalemia,hypovolemia,systemic diseases or fever.The major elimination and falling standards:(1)does not conform to after the discovery of the inclusion criteria;(2)lost contact,unable to come to the hospital and follow up for some reason,and automatically to withdraw from the study in the whole process of the research;(3)appears accident in the process of our study or any other serious diseases,infectious diseases,and could not continue the research.MethodsThe method of prospective cohort study with randomized double blind was used in our study.Relevant observation index comparison were processed between the experimental and control groups on the 1,3,6 follow-up months respectively,to evaluate the CR effect of two groups’ management.The specific method is as follows:1.We implemented the development of reasonable standard on CR program,including in-patient and out-patient rehabilitation.2.In order to assure that the procedures of monitoring,adjustment,feedback and communication could be fulfilled in real-time on obesity management in CR,We made use of networked methods on the management of CR,such as Wechat platform,Tencent QQ and network station.That is also providing the intelligent integrated service on obesity management in CR.3.We gathered the general information including the basic information of the patients(such as age,gender,smoking,etc.).After then,we educated our patients with the knowledge of cardiac rehabilitation,obesity management concept and how to operate them in practice.Fourthly,we managed the CR program on the experimental group with the intelligent network management mode,and follow-up the control group with receiving general treatment.We were making follow-up by telephone,network and tracking patients in outpatient and so on.We arranged the discharged cases timely visit us after 1,3,6 months regular follow-up,and collected the indexes which mainly including BMI,WC,Weight,Hight,heart rate(HR),systolic blood pressure(BP),diastolic blood pressure(DBP),serum uric acid values(UA),fasting blood glucose(FBG),total cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL_C),high density lipoprotein cholesterol(HDL_C),interventricular septal thickness at diastole(IVSd),left ventricular posterior wall end diastolic dimension(LVPwd),left ventricular end diastolic dimension(LVDd),ejection fraction(EF),fractional shortening(FS),treadmill exercise time(in min),metabolic equivalents(METs),maximum net ST segment deviation,Duke treadmill score(DTS)and so on.4.Our study is using the SPSS 19.0 to input and management income data.Independent-sample T test was used for the analysis of continuous variables,while chi-square test was for categorical variables.And we also use repeated measurement data analysis of variance to analyze the statistical significance of the repeated measurement of the indexes.Meanwhile,we analyzed the correlation between the parameters through the correlation analysis,linear regression analysis and multiple linear regression analysis.Results1.The statistical result of the baseline characteristics of the hospital information:(1)The experimental group has 61 cases,aged(49.7±7.9)years and weighted(69.8±8.9)kg shows the characteristic with 91.8%males gender,75.4%smoking rate,36.1%diabetes rate,45.9%hypertension rate,82%dyslipidemia rate,8.2%left main disease,62.3%three-vessel disease,72.1%complicated coronary artery disease.The average BMI of experimental group is(24.9±2.6)kg/m2,and the WC is(91.9±9.6)cm.(2)The control group has 53 cases,aged(52.4±6.7)years old and weighted(67.7±9.3)kg shows the characteristic 90.6%males gender,62.3%smoking rate,11.3%diabetes rate,34%hypertension rate,81.1%dyslipidemia rate,5.7%left main disease(LMD),17%three-vessel disease(TVD),47.2%complicated coronary artery disease(CCAD).The average BMI of experimental group is(24.1±3.0)kg/m2,and the WC is(87.6±9.7)cm.2.The relative statistical result of the effect of the rehabilitation on the experimental group and the control group:(1)Compared with the measurement index of the admission,the experimental group with the network management in CR on 1,3 and 6 months were improved on some indexes including HR,WC,TC,TG,LDL_C,and some statistically significant indicators in a certain period of CR time were including the FBG,blood pressure(SBp,DBp),cardiac index(LVPwd),the structure of the cardiac function indexes(EF,Maximum net ST segment deviation,DTS).But the control group without the network management in CR was observed in 1,3 and 6 follow-up months were improved in only TC,TG,LDL_C index,some statistically significant indicators in a certain period of CR time were including smoking proportion index,blood pressure index(SBp,DBp),cardiac index(LVPwd,IVSd structure),the heart function index(exercise time,METs).The experimental group after the management network in CR for 6 months,compared with the measurement index in hospitalization,WC,HR,TC,TG,LDL_C,LVPwd,Maximum net ST segment deviation,and the DTS index improved,while only in TC and TG,LDL_C,IVSd index improved on the control group.(2)The comparison between the experimental and control group,on the management after 1 months,the experimental group of lipid indicators(TC)was better improved than the control group;after 3 months compared with the control group,DBp,exercise time,METs index of the experimental group was better improved;in management after 6 months,compared with the control group,the FS index of the experimental group improved better.3.The result of the repeated measurement data analysis of variance of the indexes:The measurement indicators for the variance analysis of repeated measurements found that HR,SBp,blood lipid indexes(TC,TG,LDL_C,HDL_C)have the significance difference in repeated measurements within the experimental or control group respectively,but have no significance difference between the experimental and control group.4.The different effect on BMI,WC index in diagnosis and evaluating the prognosis on follow-up with CR after ACS:(1)There is a certain degree of the significance positive correlation between the BMI/WC and the hypertension indexes(SBP and DBP),but the BMI index appears more obviously correlated with the hypertension indexes than WC.(2)There is a certain degree of the significance negative correlation between the WC solely and the HDL_C index.The BMI index appears no correlation of it.(2)There is a certain degree of the significance positive correlation between the WC solely and the cardiac structure indexes of IVSd,LVPwd.The BMI index appears no correlation of it.Conclusion1.Compare to BMI,our research discovers that WC is simple and practicable,can timely evaluate the effect of rehabilitation and adjust the CR program.2.WC can accurately predict the damage on the target organ.Our research concluded that WC will decrease as the time progresses of our CR proceedings.3.It is worth to popularize the networked methods on the management of CR. |
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