Abstract 19130: Referral to Cardiac Rehabilitation: A Quality Indicator Associated with Reduced Mortality
Notice bibliographique
Résumé
Background: Cardiac Rehabilitation (CR) is an efficacious, evidence based treatment for reducing mortality and hospitalization in subjects with coronary artery disease (CAD). CR referral is an indicator of quality care in CAD patients. However, not all eligible subjects are referred for CR. The objective of this study was to assess predictors of referral to CR and the association between referral and mortality. Methods: All subjects who underwent coronary angiography between 1995 and 2009 and were found to have CAD were included in this study (n=25,958, 24.6% female). Referral to CR and subsequent attendance were evaluated. Baseline characteristics were compared between those who were referred and not. Logistic regression models predicting referral were developed. Using cox proportional hazards models, survival was then compared across those who were not referred (NR), referred and did not attend, and referred and did attend. Results: Of those subjects with CAD, 10236 (39.4%) were referred to CR; 58.4% of those referred attended CR. Rates of referral increased from 20.7 to 65.3% over the course of the study (p<0.0001). In multivariate models, older age, being female, and diabetes all predicted non-referral (all p<0.0001). Relative to the NR, those who were referred and did not attend had a hazard ratio (HR) for mortality of 0.55 (95% CI 0.51, 0.60); those who were referred and attended had a HR of 0.26 (95% CI 0.24, 0.29). When adjusted for age, sex, CAD severity, treatment (surgical, interventional, medical) and all clinical covariates, subjects who were referred and did not attend had a HR of 0.76 (95% CI 0.70, 0.82) and subjects who were referred and attended had a HR of 0.42 (95% CI 0.38, 0.46) for death relative to those who were NR. Conclusion: While CR referral rates have improved over time, they remain suboptimal. High-risk subjects are the most likely to remain un-referred. Given the association between CR referral and reduced mortality, referral to CR is a justifiable quality indicator for CAD patient care. Efforts to improve referral should be undertaken.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».