急性心肌梗塞病人接受第一期心臟復健之性別差異

Gender Difference in Acute Myocardial Infarction Patients Receiving Phase 1 Cardiac Rehabilitation

何啟傑(Chi-Che Ho) ； 陳怡如(Yi-Ru Chen) ； 何宗翰(Chung-Han Ho) ； 林彣芷(Wen-Chih Lin) ； 楊舒涵(Shu-Han Yang) ； 阮惠群(Hui-Chun Juan) ； 周偉倪(Willy Chou)

《台灣復健醫學雜誌》 42卷4期 (2014/12) Pp. 199-205

https://doi.org/10.6315/2014.42(4)03

摘要

研究目的：心血管疾病之致病機轉、流行病學、診斷、處置及預後之性別差異已被廣為探討，不同性別接受心臟復健亦有所影響，然而少有研究針對急性心肌梗塞病人接受第一期心臟復健作性別差異探討。本文欲利用台灣健保資料庫，分析急性心肌梗塞後接受第一期心臟復健病人其年齡分布、共病症及醫療處置之性別差異探討，期可提供心臟復健團隊成員在日後擬定訓練計畫時之參考依據。研究方法：利用台灣健保資料庫住院復健檔，收集1998年到2011年的資料，擷取國際疾病分類號碼第九版（ICD-9-CM）主診斷代碼申報為410，定義為急性心肌梗塞，並於住院中接受心臟復健（申報碼CPT5）者。分析男性與女性之年齡差異、老年比例、查爾森共病症指數及各共病症所占比例。結果：於1998－2011年共收集了8189位因急性心肌梗塞住院，並接受第一期心臟復健的病人，平均年齡65.65±12.59歲，六十五歲以上之老年人有4475（54.64%）人，其中有1032（12.6%）人大於等於八十歲。性別差異方面，男性較多，佔6266（76.52%)人，平均年齡較女性為低（64.36±12.79 vs 69.85±10.90,p＜.0001）。女性中老年人所佔比例較高（70.31% vs.49.84%, p＜.0001），且共病症較嚴重。查爾森共病症中，較常見之共病為糖尿病（39.36%）、充血性心臟衰竭（25.83%）、腦血管疾病（10.89%）、慢性肺部疾病（7.64%）、中度或重度腎臟疾病（7.31%）。以上共病症中，男性伴有慢性肺部疾病之比例較女性為高；女性伴有充血性心臟衰竭、腦血管疾病、風濕性疾病、糖尿病及其併發症、腎臟病變皆較男性為多。結論：本研究利用台灣健保資料庫分析急性心肌梗塞病人接受第一期心臟復健之性別差異，發現女性所佔比例較少，但其平均年齡較高、較多比例為多重共病症、查爾森共病症指數較高，亦有較高比例併有糖尿病、充血性心臟衰竭、腦血管疾病等預後較差之共病，此可做為運動處方擬定與訓練目標設定之參考，並建議女性急性心肌梗塞病人應更積極接受第一期心臟復健以改善預後。

關鍵字

性別差異 ； 急性心肌梗塞 ； 第一期心臟復健

並列摘要

Purpose: The effects of gender difference on the pathogenesis, epidemiology, diagnosis, treatment, and prognosis of cardiovascular diseases have been widely examined. In addition, gender differences influence cardiac rehabilitation; however, few studies have investigated the effect of gender difference on phase 1 cardiac rehabilitation patients. Therefore, this study explored gender difference in acute myocardial infarction patients who received phase 1 cardiac rehabilitation based on data collected from the National Health Insurance Research Database. For our analysis, we focused on the age distribution, comorbidities, and medical treatment of these patients. The study results are expected to serve as a reference for cardiac rehabilitation staff when developing training programs for patients. Method: Data spanning from 1998 to 2011 were collected from the inpatient rehabilitation profiles in the database. We defined acute myocardial infarction according to the primary diagnostic code 410 of the International Classification of Diseases, Ninth Revision, Clinical Modification, and targeted inpatients who received cardiac rehabilitation treatment. We analyzed the age difference, proportion of elderly people, Charlson comorbidity index score, and proportion of other comorbidities in patients of both genders. Results: We collected data spanning from 1998 to 2011 on 8189 patients who were hospitalized for acute myocardial infarction and who received phase 1 cardiac rehabilitation treatment. The average age of the patients was 65.65 ± 12.59 years. Among the patients, 4475 (54.64%) were elderly patients aged 65 years or older, and 1032 (12.6%) were aged 80 years or older. Regarding gender difference, the male patients accounted for most of the population, with a total number of 6266 (76.52%), and their average age was lower than that of the female patients (64.36 ± 12.79 y vs 69.85±10.90 y, p ＜ .0001). Among the female patients, the proportion of elderly people was high (70.31% vs 49.84%, p ＜ .0001), and the condition of comorbidities was severe. Regarding the Charlson comorbidities, common diseases included diabetes (39.36%), congestive heart failure (25.83%), cerebrovascular disease (10.89%), chronic lung disease (7.64%), and moderate or severe kidney disease (7.31%). The proportion of male patients with chronic lung disease was higher than that of female patients. In addition,the proportion of female patients with congestive heart failure, cerebrovascular disease, rheumatic disease, diabetes and its complications, and kidney disease was higher than that of male patients. Conclusion: This study adopted data from the National Health Insurance Research Database and analyzed gender difference in acute myocardial infarction patients who received cardiac rehabilitation. The results showed that the female patients accounted for a lower proportion compared with the male patients; however, the average age of the female patients was higher, and they exhibited multiple comorbidities, a higher Charlson comorbidity index score, and higher proportion of comorbidities with poor prognoses, including diabetes, congestive heart failure, and cerebrovascular disease. These findings can be used as a reference for developing exercise prescriptions and training targets. Based on the study results, we recommend female patients with acute myocardial infarction to improve their prognosis conditions by accepting phase 1 cardiac rehabilitation.

並列關鍵字

gender difference ； acute myocardial infarction ； phase 1 cardiac rehabilitation

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