Повторні заняття поліпшують дотримання 


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Повторні заняття поліпшують дотримання



Велике обсерваційне дослідження дійшло висновку, що кількість реабілітаційних сеансів (тобто, тривалість та інтенсивність втручань і мотивація учасників) корелювали з кращим прогнозом. [67] Це було підтверджено результатами дослідження Global Secondary Prevention Strategies to Limit Event Recurrence After MI (GOSPEL), в якому довготривале втручання було більш ефективним, порівняно з короткотривалим. [565]

Для довготривалих результатів не мало особливого значення, чи проводилася реабілітація в стаціонарних умовах або ж амбулаторно, набагато більше значення мали тривалість програми, освітній рівень, мотивація пацієнтів. [205]

Рівень залучення пацієнтів у такі програми досить низький: у Європі лише 30% пацієнтів, яким показана реабілітація, беруть участь в таких програмах з істотними відмінностями між країнами. [5] Хоча кардіологічна реабілітація економічно ефективна з перспектив для громади, більшою проблемою в майбутньому буде підвищення рівня участі пацієнтів по всій Європі.

Найбільш важлива нова інформація.

• Кардіологічна реабілітація економічно ефективна щодо зниження ризику серцево-судинних подій.

 

Решта прогалини у доказовій базі:

• Оптимальна тривалість програм кардіологічної реабілітації залишається неясною.

 

Програми неурядових організацій

Основні тези

• Неурядові організації є важливими партнерами працівників охорони здоров'я у розвитку профілактичної кардіології.

EHN – неурядова європейська організація з координаційним центром у Брюсселі, до складу якої входять підрозділи з 26 країн. EHN відіграє провідну роль у профілактиці, особливо захворювань серця та інсульту шляхом пропаганди, створення мереж, освіти та підтримки пацієнтів, так вони більше не будуть основною причиною передчасної смерті та інвалідності в Європі. [568]

Для досягнення своєї мети EHN присвячує свою діяльність зміні європейської політики на користь здорового способу життя, створення взаємозв'язків між організаціями, які займаються зміцненням серцево-судинного здоров'ям, обробці та поширенню інформації, яка стосується проблем здоров'я серцево-судинної системи і зміцнення членства.

EHN працює через експертні групи, робота яких сфокусована на проблемах здорового харчування, політиці тютюнокуріння, професійного здоров'я, психологічних факторах та фізичній активності, як природній частині повсякденного життя.

EHN полегшує мережеву роботу серед організацій-членів, які активно підтримують кардіологічних пацієнтів та пацієнтів після інсульту.

Приблизно половина членів організацій підпадають під цю категорію. Організації кардіологічних пацієнтів забезпечують своїх учасників-пацієнтів можливістю отримання підтримки від пацієнтів з такими ж проблемами. Вони створюють інформацію для пацієнта у вигляді буклетів і веб-матеріали, і вони сприяють кардіологічній реабілітації.

 

Дії на європейському політичному рівні

Основні тези

• Статут європейської асоціації серця ознаменував початок нової ери політичного впливу на профілактичну кардіологію.

У 2002 Рада Європейської асоціації серця підкреслила важливість майбутньої участі в політиці охорони здоров'я, оголосивши стратегії для держав-членів знизити смертність від серцево-судинних захворювань на 40%. Було ясно, що для медичних працівників, щоб впливати на політику прийняття рішень на національному рівні та на рівні ЄС, необхідна тісна взаємодія з іншими неурядовими організаціями, в першу чергу з EHN, а так само з місцевими організаціями та ЄС. Робота розпочалася шляхом проведення точної експертизи і представлення тривожної статистики про величезну кількість і нерівномірність ССЗ в Європі, і в результаті був заклик до дії від держав-членів та Європейської комісії вирішувати проблему ССЗ.

За цією ініціативою слідувало партнерство під час головування Ірландії в РЄ в 2004 році. Був зроблений висновок, що більшості випадків ССЗ можна запобігти за допомогою зміни способу життя і правильного застосування існуючих ліків. Наступні висновки Ради ЄС з ССЗ були першою політичною заявою на рівні ЄС, визнаючи необхідність поліпшення здоров'я ССЗ в Європі. Успішне співробітництво під час головування Люксембургу, Австрії та Португалії разом з EHN проклали шлях до створення Європейської Хартії European Heart Health. Ця Хартія вступила в силу в червні 2007 року в Європейському парламенті і була схвалена Європейською комісією та ВООЗ по Європі. Це проклало шлях для Резолюції Європейського парламенту щодо заходів з боротьби з серцево-судинними захворюваннями, сильної політичної угоди щодо необхідності профілактики ССЗ в Європі. [568] Хартія окреслює універсальні мішені і цілі для профілактики ССЗ і окреслює дії, які повинні бути прийняті для того, щоб досягти цих цілей. Вона була переведена на 26 мов і офіційно прийнята 30 країнами-членами ЄС та іншими європейськими країнами. [6]

У наступний період ESC розуміє перспективу від політиків, які приймають рішення, що об'єднавши зусилля можна зробити голос більш сильним і впливовим. Для того, щоб домогтися успіху, треба було об'єднати різні науки, щоб передати одне повідомлення, корисне для всіх захворювань, представлених у групі. У червні 2009 року ESC запрошує медичні організації, які представляють діабет, респіраторні захворювання і рак, щоб відобразити загальні детермінанти здоров'я, визначити області з достатніми доказами, щоб підтримати рекомендації, і обговорити майбутню співпрацю. Були визначені чотири ФР як досить загальні для виправдання спільних дій: тютюн, харчування, споживання алкоголю і фізична активність. Таким чином, було встановлено Європейський альянс хронічних захворювань. Цей альянс в даний час включає 10 некомерційних європейських організацій, які представляють >100 000 професіоналів охорони здоров’я. У ньому розглядаються всі основні неінфекційні хронічні захворювання, у тому числі серцево-судинні захворювання, інсульт, гіпертензія, ЦД, захворювання нирок, рак, респіраторні захворювання та захворювання печінки.[172] Альянс, який сприятиме контролю ФР населення, має потенціал великого впливу на здоров'я населення та економію коштів на охорону здоров'я.

На закінчення, автори настанови сподіваюся, що цей документ виступатиме за реальне партнерство між політиками, лікарями, суміжним персоналом в охороні здоров'я, науковими асоціаціями, кардіологічними фондами, волонтерськими організаціями, асоціації споживачів щодо сприяння і зміцнення здоров'я на рівні населення та первинної і профілактики ССЗ на клінічному рівні, використовуючи повний спектр доказів в медицині від експериментальних досліджень до спостереження в популяціях.

 


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