09 June 2025 : Clinical Research
Self-Management-Centric Cardiac Rehabilitation for Acute Coronary Syndrome Patients During the COVID-19 Pandemic
Yiwen Wang ABCE 1, Haowen Shi BCEF 1, Min Zhang BDF 1, Yang Duan D 1, Zhi Li BDF 1, Lei Chen BCD 1, Yixuan Wu BCF 1, Yanfei Ren BF 1, Yuan Lu ADEG 1*DOI: 10.12659/MSM.947235
Med Sci Monit 2025; 31:e947235
Table 2 Clinical characteristics of SMCCRNF and SMCCRF groups before and after matched pairing.
| Characteristics, n (%) | Entire cohort | P value | SMD | Matched-pair group | P value | SMD | ||
|---|---|---|---|---|---|---|---|---|
| SMCCRNF (n=842) | SMCCRF (n=785) | SMCCRNF (n=619) | SMCCRF (n=619) | |||||
| Diagnosis | 0.306 | 0.053 | 0.775 | 0.019 | ||||
| NSTEACS | 401 (47.62) | 353 (44.97) | 279 (45.07) | 285 (46.04) | ||||
| STEMI | 441 (52.38) | 432 (55.03) | 340 (54.93) | 334 (53.96) | ||||
| Age, (median [IQR]), y | 68.00 [57.00, 76.00] | 63.00 [54.00, 72.00] | 0.336 | 65.00 [55.00, 74.00] | 65.00 [56.00, 73.00] | 0.830 | 0.019 | |
| Male | 583 (69.24) | 583 (74.27) | 0.112 | 449 (72.54) | 450 (72.70) | 1.000 | 0.004 | |
| Rurality | 486 (57.72) | 324 (41.27) | 0.333 | 300 (48.47) | 300 (48.47) | 1.000 | <0.001 | |
| High school degree/above | 393 (46.67) | 431 (54.90) | 0.165 | 322 (52.02) | 312 (50.40) | 0.609 | 0.032 | |
| Employed | 240 (28.50) | 318 (40.51) | 0.255 | 214 (34.57) | 210 (33.93) | 0.857 | 0.014 | |
| Marital status | 0.846 | 0.016 | 1.000 | 0.008 | ||||
| Married | 805 (95.61) | 753 (95.92) | 594 (95.96) | 595 (96.12) | ||||
| Single/divorced | 37 (4.39) | 32 (4.08) | 25 (4.04) | 24 (3.88) | ||||
| SBP, (median [IQR]), mmHg | 130.00 [116.00, 147.00] | 131.00 [115.00, 146.00] | 0.779 | 0.021 | 130.00 [116.00, 146.00] | 131.00 [115.50, 147.00] | 0.567 | 0.034 |
| HR, (median [IQR]), bpm | 78.50 [69.00, 90.00] | 78.00 [69.00, 88.00] | 0.374 | 0.060 | 78.00 [68.50, 89.50] | 78.00 [69.00, 88.00] | 0.804 | 0.025 |
| Atrial fibrillation | 43 (5.11) | 39 (4.97) | 0.988 | 0.006 | 31 (5.01) | 32 (5.17) | 1.000 | 0.007 |
| Malignant arrhythmia | 36 (4.28) | 40 (5.10) | 0.506 | 0.039 | 27 (4.36) | 28 (4.52) | 1.000 | 0.008 |
| Heart failure | 102 (12.11) | 59 (7.52) | 0.155 | 56 (9.05) | 52 (8.40) | 0.763 | 0.023 | |
| Cardiogenic shock | 20 (2.38) | 16 (2.04) | 0.769 | 0.023 | 16 (2.58) | 12 (1.94) | 0.566 | 0.043 |
| Stroke | 121 (14.37) | 89 (11.34) | 0.08 | 0.091 | 76 (12.28) | 78 (12.60) | 0.931 | 0.010 |
| Prior PCI/CABG | 127 (15.08) | 80 (10.19) | 0.148 | 74 (11.95) | 74 (11.95) | 1.000 | <0.001 | |
| Renal dysfunction | 61 (7.24) | 37 (4.71) | 0.107 | 32 (5.17) | 33 (5.33) | 1.000 | 0.007 | |
| EH | 348 (41.33) | 328 (41.78) | 0.893 | 0.009 | 251 (40.55) | 258 (41.68) | 0.729 | 0.023 |
| DM | 219 (26.01) | 181 (23.06) | 0.185 | 0.069 | 150 (24.23) | 146 (23.59) | 0.842 | 0.015 |
| Dyslipidaemia | 100 (11.88) | 131 (16.69) | 0.138 | 85 (13.73) | 87 (14.05) | 0.935 | 0.009 | |
| LVEF category | 0.192 | 0.727 | 0.045 | |||||
| ≤40% | 82 (9.74) | 46 (5.86) | 44 (7.11) | 42 (6.79) | ||||
| 41–49% | 178 (21.14) | 134 (17.07) | 120 (19.39) | 110 (17.77) | ||||
| ≥50% | 582 (69.12) | 605 (77.07) | 455 (73.51) | 467 (75.44) | ||||
| LVEDD, (median [IQR]), mm | 50.00 [48.00, 53.00] | 50.00 [47.00, 53.00] | 0.154 | 0.088 | 50.00 [48.00, 52.00] | 50.00 [47.00, 53.00] | 0.799 | 0.003 |
| Pulmonary hypertension | 0.160 | 0.811 | 0.037 | |||||
| Mild | 99 (11.76) | 63 (8.03) | 60 (9.69) | 54 (8.72) | ||||
| Moderate | 17 (2.02) | 9 (1.15) | 9 (1.45) | 8 (1.29) | ||||
| Killip level (median [IQR]) | 1.00 [1.00, 1.00] | 1.00 [1.00, 1.00] | 0.155 | 1.00 [1.00, 1.00] | 1.00 [1.00, 1.00] | 0.132 | 0.082 | |
| Urgency of PCI | 0.281 | 0.923 | 0.039 | |||||
| No PCI | 121 (14.37) | 52 (6.62) | 55 (8.89) | 52 (8.40) | ||||
| Emergency | 426 (50.59) | 470 (59.87) | 351 (56.70) | 348 (56.22) | ||||
| Urgent | 117 (13.90) | 118 (15.03) | 97 (15.67) | 94 (15.19) | ||||
| Elective | 178 (21.14) | 145 (18.47) | 116 (18.74) | 125 (20.19) | ||||
| HLOS, (median [IQR]), d | 5.00 [4.00, 7.00] | 5.00 [4.00, 6.00] | 0.839 | 0.017 | 5.00 [4.00, 7.00] | 5.00 [4.00, 6.00] | 0.949 | 0.040 |
| ICU living | 20 (2.38) | 12 (1.53) | 0.294 | 0.061 | 12 (1.94) | 11 (1.78) | 1.000 | 0.012 |
| DAPT | 835 (99.17) | 784 (99.87) | 0.094 | 0.102 | 619 (100.00) | 618 (99.84) | 1.000 | 0.057 |
| Statin | 837 (99.41) | 784 (99.87) | 0.254 | 0.078 | 618 (99.84) | 618 (99.84) | 0.364 | 0.102 |
| ACEI/ARB/ARNI | 518 (61.52) | 502 (63.95) | 0.337 | 0.050 | 379 (61.23) | 396 (63.97) | 0.347 | 0.057 |
| β-blocker | 647 (76.84) | 647 (82.42) | 0.139 | 503 (81.26) | 503 (81.26) | 1.000 | <0.001 | |
| MRA | 131 (15.56) | 68 (8.66) | 0.213 | 64 (10.34) | 61 (9.85) | 0.850 | 0.016 | |
| SGLT2inhibitors | 136 (16.15) | 115 (14.65) | 0.442 | 0.042 | 94 (15.19) | 91 (14.70) | 0.873 | 0.014 |
| BMI, (median [IQR]), kg/m | 24.59 [22.22, 27.03] | 24.97 [22.89, 27.34] | 0.096 | 24.68 [22.45, 27.24] | 24.80 [22.77, 27.10] | 0.484 | 0.022 | |
| HbA1c, (median [IQR]), % | 6.72 [6.00, 6.80] | 6.20 [5.80, 6.72] | 0.200 | 6.72 [5.90, 6.72] | 6.30 [5.80, 6.72] | 0.033 | 0.024 | |
| LDL-C, mmol/L | 2.67 [2.07, 3.09] | 2.70 [2.14, 3.23] | 0.100 | 2.69 [2.10, 3.14] | 2.69 [2.09, 3.16] | 0.88 | 0.009 | |
| TC, mmol/L | 4.32 [3.63, 4.86] | 4.37 [3.73, 5.01] | 0.063 | 0.072 | 4.36 [3.68, 4.89] | 4.35 [3.71, 4.95] | 0.787 | 0.012 |
| Smoking status | 0.164 | 0.094 | 0.759 | 0.042 | ||||
| Never | 370 (43.94) | 339 (43.18) | 264 (42.65) | 259 (41.84) | ||||
| Former | 138 (16.39) | 106 (13.50) | 81 (13.09) | 90 (14.54) | ||||
| Yes | 334 (39.67) | 340 (43.31) | 274 (44.26) | 270 (43.62) | ||||
| hsTnT, ng/L | 1746.50 [437.47, 3590.75] | 2027.00 [564.00, 4076.00] | 0.107 | 0.055 | 1895.00 [459.75, 4019.00] | 1924.00 [533.00, 3915.50] | 0.793 | 0.021 |
| CKMB, ng/mL | 40.75 [5.79, 160.49] | 71.31 [10.85, 201.50] | 0.171 | 53.12 [7.50, 202.21] | 60.12 [9.41, 177.76] | 0.935 | 0.047 | |
| NT-proBNP, pg/mL | 2363.50 [910.90, 5313.75] | 1583.10 [731.00, 3242.94] | 0.31 | 1903.00 [789.10, 4002.95] | 1838.01 [836.12, 3772.80] | 0.694 | 0.069 | |
| eGFR, ml/min/1.73 m | 89.78 [72.49, 101.00] | 94.91 [80.66, 105.80] | 0.256 | 93.80 [77.90, 103.10] | 93.80 [78.76, 104.70] | 0.447 | 0.027 | |
| SMCCRNF – self-management-centric cardiac rehabilitation unfinished; SMCCRF – self-management-centric cardiac rehabilitation finished; SMD – standardized mean difference; STEMI – ST-segment elevation myocardial infarction; NSTEACS – non-ST-segment elevation acute coronary syndrome; IQR – inter-quartile range; SBP – systolic blood pressure; HR – heart rate; PCI – percutaneous coronary intervention; CABG – coronary artery bypass grafting; EH – essential hypertension; DM – diabetes mellitus; LVEF – left ventricular ejection fraction; LVEDD – left ventricular end-diastolic dimension; HLOS – hospital length of stay; ICU – intensive care unit; DAPT – dual antiplatelet therapy; ACEI – angiotensin-converting enzyme inhibitor; ARB – angiotensin receptor blocker; ARNI – angiotensin receptor-neprilysin inhibitor; MRA – mineralocorticoid receptor antagonist; SGLT2 – sodium-dependent glucose transporters 2; BMI – body mass index; LDL-C – low density lipoprotein cholesterol; TC – total cholesterol; hsTnT – high-sensitivity troponin T; CKMB – creatine kinase MB isoenzyme; NT-proBNP – N-terminal pro-B-type natriuretic peptide; eGFR – estimated glomerular filtration rate. | ||||||||