经皮冠状动脉介入治疗术后患者心脏康复依从性潜在类别转变及其影响因素研究OA

Objective To analyze the latent classes of cardiac rehabilitation adherence in patients after percutaneous coronary intervention(PCI)and the characteristics of their changes over time and influencing factors.Methods A convenience sampling method was used to select 430 PCI patients from the cardiac rehabilitation department of the Second Affiliated Hospital of Harbin Medical University between August 2021 and December 2022 as the study subjects.Seventeen patients were lost to follow-up,and 413 patients completed the 1-year follow-up.At the end of Phase I cardiac rehabilitation(T1),surveys were conducted using general demographic questionnaire,the PCI Patient Treatment Adherence Questionnaire,the Coronary Heart Disease Health Belief Scale(CHD-HBS),the Brief Illness Perception Questionnaire(BIPQ),the Patient Health Questionnaire-Depression Scale 9-item(PHQ-9),the Generalized Anxiety Disorder Scale 7-item(GAD-7),the Family Adaptability and Cohesion Evaluation Scale(FACES),and the Chronic Illness Resources Survey(CIRS).At the end of Phase Ⅱ(T2)and Phase Ⅲ(T3),one-on-one follow-up interviews were conducted based on the PCI Patient Treatment Adherence Questionnaire.Latent class analysis was used to determine the optimal number of models and groupings,and the proportions of each group at different time points were compared.Latent transition proba-bilities of cardiac rehabilitation adherence were compared,and their influencing factors were analyzed.Results The optimal num-ber of latent class models was determined to be 2 based on overall category consistency.Two models were named using the level-based naming method:Model 1 was named the partial adherence group,and Model 2 was named the full adherence group.The pro-portions of patients in the partial adherence group at T1,T2,and T3 were 56.42%,61.02%,and 70.00%,respectively,while the pro-portions of patients in the full adherence group at T1,T2,and T3 were 43.58%,38.98%,and 30.00%,respectively.From T1 to T2,T2 to T3,and T1 to T3,the probability of the full adherence group remaining in the original latent class was 78.03%,81.26%,and 71.15%,respectively,with the probability of transitioning to the partial adherence group being 21.97%,18.74%,and 28.85%,respec-tively.For the partial adherence group,the probability of remaining in the original latent class from T1 to T2 was 91.54%,with a probability of transitioning to the full adherence group of 8.46%.From T2 to T3 and T1 to T3,the probability of the partial adher-ence group remaining in the original latent class were both 100%.From T1 to T2,the influencing factors for the transition from full adherence to partial adherence included age(χ²=26.186,P<0.001),employment status(χ²=18.02,P<0.001),smoking history(χ²=4.381,P=0.036),alcohol consumption history(χ²=4.91,P=0.027),BMI(χ²=7.567,P=0.023),number of prior medical conditions(χ²=14.526,P=0.013),CHD-HBS score(t=23.191,P<0.001),BIPQ score(t=11.628,P<0.001),depression(χ²=51.488,P<0.001),anxiety(χ²=37.725,P<0.001),FACES score(t=28.309,P<0.001),and CIRS score(t=33.579,P<0.001).From T2 to T3,influencing factors included education level(χ²=4.609,P=0.019),CHD-HBS score(t=6.175,P<0.001),depression(χ²=4.651,P=0.031),anxiety(χ²=3.901,P=0.048),FACES score(t=4.037,P<0.001),and CIRS score(t=5.829,P<0.001).From T1 to T3,influencing factors in-cluded age(χ²=24.503,P<0.001),employment status(χ²=20.475,P<0.001),CHD-HBS score(t=3.577,P=0.040),BIPQ score(t=2.084,P<0.001),and CIRS score(t=3.704,P<0.001).From T1 to T2,employment status(χ²=3.147,P=0.016)and medical cost pay-ment method(χ²=0.299,P=0.037)were identified as influencing factors for the transition from partial adherence to full adherence.The main influencing factors for the transition from full adherence to partial adherence from T1 to T2 included employment status(OR=4.352,P=0.029),CHD-HBS score(OR=0.931,P=0.021),and BIPQ score(OR=1.091,P=0.025).The main influencing factors for the transition from full adherence to partial adherence from T2 to T3 included education level below high school(OR=6.598,P=0.011;OR=6.273,P=0.048),CHD-HBS score(OR=0.919,P=0.004),and FACES score(OR=0.900,P=0.017).The key influencing factors for the transition from full adherence to partial adherence from T1 to T3 included employment status(OR=3.581,P=0.024)and BIPQ score(OR=1.072,P=0.035).The main influencing factor for the transition from partial adherence to full adherence from T1 to T2 was the medical cost payment method being covered by insurance(OR=2.818,P=0.043).Conclusion Cardiac rehabilita-tion adherence in post-PCI patients exhibits heterogeneity,and latent class transition analysis reveals the transition patterns and influ-encing factors between the full and partial adherence groups.