Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga
Digital
- Autores:
-
Badillo-Mojica, Silvia Alejandra
- Tipo de recurso:
- Trabajo de grado de pregrado
- Fecha de publicación:
- 2025
- Institución:
- Universidad de Santander
- Repositorio:
- Repositorio Universidad de Santander
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.udes.edu.co:001/11604
- Palabra clave:
- Enfermedad Cardiovascular
Revascularización Miocárdica
Rehabilitación Cardiaca
Cardiovascular Disease
Myocardial Revascularization
Cardiac Rehabilitation
- Rights
- openAccess
- License
- http://purl.org/coar/access_right/c_abf2
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Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga |
| dc.title.translated.none.fl_str_mv |
Factors Associated with Participation and Adherence of Revascularized Patients Referred to the Cardiac Rehabilitation Phase II Program at Los Comuneros Hospital Universitario of Bucaramanga |
| title |
Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga |
| spellingShingle |
Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga Enfermedad Cardiovascular Revascularización Miocárdica Rehabilitación Cardiaca Cardiovascular Disease Myocardial Revascularization Cardiac Rehabilitation |
| title_short |
Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga |
| title_full |
Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga |
| title_fullStr |
Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga |
| title_full_unstemmed |
Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga |
| title_sort |
Factores Asociados a la Participación y Adherencia de los Pacientes Revascularizados Derivados al Servicio de Rehabilitación Cardíaca Fase II de Los Comuneros Hospital Universitario de Bucaramanga |
| dc.creator.fl_str_mv |
Badillo-Mojica, Silvia Alejandra |
| dc.contributor.advisor.none.fl_str_mv |
Sánchez-Delgado, Juan Carlos Angarita-Fonseca, Adriana Hinestroza, Alfredo Pérez, Laura Liliana |
| dc.contributor.author.none.fl_str_mv |
Badillo-Mojica, Silvia Alejandra |
| dc.contributor.jury.none.fl_str_mv |
Negrete-Madera, Maria de los Angeles Carvajal-Estupinan, Juan Fernando Buitrago-Buitrago, Jhosman Alfonso |
| dc.subject.proposal.spa.fl_str_mv |
Enfermedad Cardiovascular Revascularización Miocárdica Rehabilitación Cardiaca |
| topic |
Enfermedad Cardiovascular Revascularización Miocárdica Rehabilitación Cardiaca Cardiovascular Disease Myocardial Revascularization Cardiac Rehabilitation |
| dc.subject.proposal.eng.fl_str_mv |
Cardiovascular Disease Myocardial Revascularization Cardiac Rehabilitation |
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Digital |
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2025 |
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2025-04-04T15:31:23Z |
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2025-04-04T15:31:23Z |
| dc.date.issued.none.fl_str_mv |
2025-02-20 |
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Trabajo de grado - Especialización |
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Repositorio Digital Institucional Universidad de Santander |
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Universidad de Santander T 104.25 B125f Repositorio Digital Institucional Universidad de Santander |
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spa |
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Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. Vol. 351, BMJ (Online). BMJ Publishing Group; 2015. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Jan 18;79(2):e21–129 Chindhy S, Taub PR, Lavie CJ, Shen J. Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers. Vol. 18, Expert Review of Cardiovascular Therapy. Taylor and Francis Ltd.; 2020. p. 777–89. Amini M, Zayeri F, Salehi M. Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC Public Health. 2021 Dec 1;21(1). Ministerio de Salud y Protección Social (Colombia). Indicadores básicos de salud 2022. Bogotá: Ministerio de Salud y Protección Social; 2022 [citado 2024 dic 5]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/GCFI/indicadores-basicos-salud-2022.pdf. WHO. World Health Organization (WHO). Cardiovascular diseases (CVDs) [Internet]. Geneva: WHO; 2023 [citado 2024 dic 5]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). 2021. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease Cochrane Systematic Review and Meta-Analysis. 2016. Hammill BG, Curtis LH, Schulman KA, Whellan DJ. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly medicare beneficiaries. Circulation. 2010 Jan;121(1):63–70. Muñoz Velandia OM, García ÁA, Bustamante ÁA, Pomares-Quimbaya A, González RA, Sierra A, et al. Automatic evaluation of the adherence to recommendations for managing heart failure from the electronic health records: The EXEMED tool. Revista Colombiana de Cardiologia. 2018 Sep 1;25(5):321–6. Rangel-Cubillos DM, Vega-Silva AV, Corzo-Vargas YF, Molano-Tordecilla MC, Peñuela-Arévalo YP, Lagos-Peña KM, et al. Examining Facilitators and Barriers to Cardiac Rehabilitation Adherence in a Low-Resource Setting in Latin America from Multiple Perspectives. Int J Environ Res Public Health. 2022 Feb 2;19(4). Sánchez Delgado JC, Jácome Hortúa A, Larios Martínez B, Pinzón S, Angarita Fonseca A. Reliability of the barriers scale for cardiac rehabilitation. Revista Colombiana de Cardiologia. 2018 Jan 1;25(1):84–91. Taylor RS, Dalal HM, McDonagh STJ. The role of cardiac rehabilitation in improving cardiovascular outcomes. Vol. 19, Nature Reviews Cardiology. Nature Research; 2022. p. 180–94. Ögmundsdottir Michelsen H, Sjölin I, Schlyter M, Hagström E, Kiessling A, Henriksson P, et al. Cardiac rehabilitation after acute myocardial infarction in Sweden – evaluation of programme characteristics and adherence to European guidelines: The Perfect Cardiac Rehabilitation (Perfect-CR) study. Eur J Prev Cardiol. 2020 Jan 1;27(1):18–27. Miller K, &&u& \ ~ M - &l&, Cadwell K, Lee TE. RELATIONSHIP BETWEEN SESSIONS ATTENDED AND OUTCOMES IN OUTPATIENT CARDIAC REHABILITATION L ! MS. Taylor JL, Bonikowske AR, Olson TP. Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity. Vol. 8, Frontiers in Cardiovascular Medicine. Frontiers Media S.A.; 2021. Falk E. Pathogenesis of Atherosclerosis. Vol. 47, Journal of the American College of Cardiology. 2006. DANE. Primer Informe ONS. Aspectos relacionados con la frecuencia de uso de los servicios de salud, mortalidad y discapacidad en Colombia, 2011. Bogotá2013. 2013. . 2013. WORLD HEART FEDERATION. DEATHS FROM CARDIOVASCULAR DISEASE SURGED 60% GLOBALLY OVER THE LAST 30 YEARS: REPORT [Internet]. 2023 [cited 2023 Oct 23]. Available from: https://world-heart-federation.org/news/deaths-from-cardiovascular-disease-surged-60-globally-over-the-last-30-years-report/#:~:text=Search%20for%3A%20Search-,Deaths%20from%20cardiovascular%20disease%20surged%2060%25%20globally,the%20last%2030%20years%3A%20Report&text=GENEVA%2C%2020%20May%202023%20%E2%80%93%20Deaths,World%20Heart%20Federation%20(WHF). Bots SH, Peters SAE, Woodward M, Sanne D, Peters AE. Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010. BMJ Glob Health [Internet]. 2017;2:298. Available from: http://dx.doi.org/ Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Vol. 40, European Heart Journal. Oxford University Press; 2019. p. 87–165. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Vol. 35, European Heart Journal. Oxford University Press; 2014. p. 2541–619. Neumann FJ, Sechtem U, Banning AP, Bonaros N, Bueno H, Bugiardini R, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Vol. 41, European Heart Journal. Oxford University Press; 2020. p. 407–77. Abubakar M, Javed I, Rasool HF, Raza S, Basavaraju D, Abdullah RM, et al. Advancements in Percutaneous Coronary Intervention Techniques: A Comprehensive Literature Review of Mixed Studies and Practice Guidelines. Cureus. 2023 Jul 3; Neumann FJ, Sousa-Uva M. “Ten commandments” for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization. Vol. 40, European Heart Journal. Oxford University Press; 2019. p. 79–80. LEVINE SA LB. The “chair” treatment of acute thrombosis. Trans Assoc Am Physicians 1951;64:316-27 PMID: 14884265. 1951; Morris JN, Heady JA. MORTALITY IN RELATION TO THE PHYSICAL ACTIVITY OF WORK A PRELIMINARY NOTE ON EXPERIENCE IN MIDDLE AGE. Brit. J. industr. Med. 1953. Saltin B, Blomqvist G, Mitchell JH, Johnson RL, Wildenthal K, Chapman CB. Response to exercise after bed rest and after training. Circulation. 1968 Nov;38(5 Suppl):VII1-78. Mampuya WM. Cardiac rehabilitation past, present and future: an overview. Cardiovasc Diagn Ther [Internet]. 2012 Mar;2(1):38–49. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24282695 Báez LP, Camacho PA, Abreu P, Arenas IC, Jaimes G. La importancia de la rehabilitación cardiovascular: experiencia en la Fundación Cardiovascular de Colombia. Revista Colombiana de Cardiología. 2006 Oct;13(2):90–6. McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Vol. 27, Trends in Cardiovascular Medicine. Elsevier Inc.; 2017. p. 420–5. Achttien RJ, Staal JB, van der Voort S, Kemps HM, Koers H, Jongert MWA, et al. Exercise-based cardiac rehabilitation in patients with chronic heart failure: A dutch practice guideline. Vol. 23, Netherlands Heart Journal. Bohn Stafleu van Loghum; 2015. p. 6–17. Carlos J, Johan RJ, De Aguas M. Configuración territorial de las provincias de Colombia Ruralidad y redes. Los Comuneros HUB. Recomendaciones post-quirúrgicas paciente coronario [Internet]. Los Comuneros HUB; c2024 [citado 2024 dic 5]. Disponible en: https://loscomuneroshub.com/educacion-al-paciente/recomendaciones-post-quirurgicas-paciente-coronario/. Instituto del Corazón. Programa de rehabilitación cardíaca [Internet]. Bogotá: Instituto del Corazón; c2024 [citado 2024 dic 5]. Disponible en: https://institutodelcorazon.org/programas-de-gestion-del-riesgo/programa-de-rehabilitacion-cardiaca/. MINISTERIO DE SALUD. Ministerio de Salud y Protección Social (Colombia). Resolución 4252 de 1997 [Internet]. Bogotá: Ministerio de Salud y Protección Social; 1997 [citado 2024 dic 5]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION_4252_de_1997.pdf. Organization WHealth. Global Health Risks : Mortality and Burden of Disease Attributable to Selected Major Risks. World Health Organization; 2009. 70 p. Chindhy S, Taub PR, Lavie CJ, Shen J. Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers. Vol. 18, Expert Review of Cardiovascular Therapy. Taylor and Francis Ltd.; 2020. p. 777–89. Lopez-Jaramillo P, Joseph P, Lopez-Lopez JP, Lanas F, Avezum A, Diaz R, et al. Risk factors, cardiovascular disease, and mortality in South America: a PURE substudy. Eur Heart J. 2022 Aug 7;43(30):2841–51. Rippe JM. Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease. Vol. 13, American Journal of Lifestyle Medicine. SAGE Publications Inc.; 2019. p. 204–12. Mensah GA, Habtegiorgis Abate Y, Abbasian M, Abd-Allah F, Abdollahi A, Abdollahi M, et al. Global Burden of Cardiovascular Diseases and Risks, 1990-2022. J Am Coll Cardiol. 2023 Dec 19;82(25):2350–473. Organization WHealth. Global Health Risks : Mortality and Burden of Disease Attributable to Selected Major Risks. World Health Organization; 2009. 70 p. Felipe Salech DM, Rafael Jara DL, Luis Michea DA. CAMBIOS FISIOLÓGICOS ASOCIADOS AL ENVEJECIMIENTO PHYSIOLOGICAL CHANGES ASSOCIATED WITH NORMAL AGING. Vol. 23, REV. MED. CLIN. CONDES. 2012. Lobos Bejarano JM, Brotons Cuixart C. Factores de riesgo cardiovascular y atención primaria: evaluación e intervención. Aten Primaria. 2011 Dec;43(12):668–77. Organización Panamericana de la Salud. Carga de enfermedades cardiovasculares en la Región de las Américas [Internet]. Washington, D.C.: OPS; 2023 [citado 13 de febrero de 2025]. Disponible en: https://www.paho.org/es/enlace/carga-enfermedades-cardiovasculares. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: Executive Summary and Recommendations A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina) Committee Members [Internet]. 2000. Available from: www.acc.org Bergmark BA, Mathenge N, Merlini PA, Lawrence-Wright MB, Giugliano RP. Acute coronary syndromes. Vol. 399, The Lancet. Elsevier B.V.; 2022. p. 1347–58. Khurshid F, Farooq Z, Ayesha UA, Chaudhry S, Malik K. A Comprehensive Review of Acute Coronary Syndrome. Annals of Innovation in Medicine. 2023 Sep 22;1(2). Simon Sarkisian CA. Guideline Only/Not a Substitute for Clinical Judgment JOINT TRAUMA SYSTEM CLINICAL PRACTICE GUIDELINE (JTS CPG) Acute Coronary Syndrome (ACS) (CPG ID:86). Organización Mundial de la Salud. Rehabilitación después de las enfermedades cardiovasculares, con especial atención a los países en desarrollo: informe de un Comité de Expertos de la OMS. Serie de Informes Técnicos No. 831. Ginebra: OMS; 1993. 94AD. Dunlay SM, Pack QR, Thomas RJ, Killian JM, Roger VL. Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. American Journal of Medicine. 2014;127(6):538–46. Dunlay SM, Witt BJ, Allison TG, Hayes SN, Weston SA, Koepsell E, et al. Barriers to participation in cardiac rehabilitation. Am Heart J. 2009 Nov;158(5):852–9. Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P. Alternative models of cardiac rehabilitation: A systematic review. Vol. 22, European Journal of Preventive Cardiology. SAGE Publications Inc.; 2015. p. 35–74. Sánchez-Delgado JC, Camargo Sepulveda DC, Cardona Zapata A, Franco Pico MY, Santos Blanco LM, Jácome Hortúa AM, et al. The Effects of Maintenance Cardiac Rehabilitation: A SYSTEMATIC REVIEW. Vol. 40, Journal of Cardiopulmonary Rehabilitation and Prevention. Lippincott Williams and Wilkins; 2020. p. 224–44. Oldridge NB, Guyatt GH, Fischer ME, Rimm AA. Cardiac Rehabilitation After Myocardial Infarction: Combined Experience of Randomized Clinical Trials. JAMA [Internet]. 1988 Aug 19;260(7):945–50. Available from: https://doi.org/10.1001/jama.1988.03410070073031 Grace SL. Evidence is indisputable that cardiac rehabilitation provides health benefits and event reduction: time for policy action. Vol. 44, European Heart Journal. Oxford University Press; 2023. p. 470–2. Clark AM, King-Shier KM, Spaling MA, Duncan AS, Stone JA, Jaglal SB, et al. Factors influencing participation in cardiac rehabilitation programmes after referral and initial attendance: Qualitative systematic review and metasynthesis. Clin Rehabil. 2013;27(10):948–59. 41. De Vos C, Li X, Eyssen M, Saka O, Dendale P, Van Vlaenderen I, et al. Participating or not in a cardiac rehabilitation programme: factors influencing a patient’s decision. Eur J Prev Cardiol. 2012;20(2):341–8. Turk-adawi KI, Oldridge NB, Tarima SS, Stason WB, Shepard DS. Cardiac Rehabilitation Patient and Organizational Factors : What. J Am Heart Assoc. 2013;2(5):1–8. 39 . |
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Bucaramanga |
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Facultad de Ciencias Médicas y de la Salud |
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Bucaramanga, Colombia |
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Especialización en Medicina Interna |
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Sánchez-Delgado, Juan Carlosfcb8661c-f452-4b10-bc96-b1179f3729cf-1Angarita-Fonseca, Adrianaccf27f75-3349-4b46-aa8e-b659527589cf-1Hinestroza, Alfredoe2d8a79e-dbda-4d58-aee9-c437545821a1-1Pérez, Laura Lilianabed4de84-304b-44c5-ba80-49fccbc0dd95-1Badillo-Mojica, Silvia Alejandracefcf2c0-bd43-429c-a30c-fabcf508ab76-1Negrete-Madera, Maria de los Angelesba9e4c13-bb3e-49ad-a8d8-679388002bce-1Carvajal-Estupinan, Juan Fernando99b37f7a-db98-44a4-a96c-88aba087027c-1Buitrago-Buitrago, Jhosman Alfonso6e6e4c6c-ce8c-4f8e-bcdc-dd7577abc99d6002025-04-04T15:31:23Z2025-04-04T15:31:23Z2025-02-20DigitalLas enfermedades cardiovasculares (ECV) son la principal causa de mortalidad a nivel mundial. La rehabilitación cardíaca (RC) ha evidenciado su eficacia en la prevención de complicaciones, la mejora de la función cardiovascular en pacientes que han sido sometidos a una revascularización miocárdica. El objetivo fue determinar los factores asociados a la participación y adherencia al programa de RC fase II en los Comuneros Hospital Universitario de Bucaramanga en pacientes revascularizados entre enero a diciembre del 2022. Para ello se desarrolló un estudio de cohorte retrospectivo de 169 historias clínicas de pacientes sometidos a revascularización coronaria en el Los Comuneros Hospital Universitario de Bucaramanga (LCHUB) y que fueron atendidos por el programa de esta misma institución durante enero a diciembre del 2022. Se realizaron regresiones logísticas simples y multivariadas en donde la variable dependiente fue la participación y adherencia del 80% al programa de rehabilitación cardiaca (PRC). La mediana de edad de los pacientes fue de 64 años, siendo la mayoría hombres (78%). No hubo diferencias entre hombres y mujeres en cuanto a la participación y adherencia a los PRC. La oportunidad de participación en los PRC fue mayor en los pacientes sometidos a un bypass en comparación con aquellos que recibieron una intervención percutánea (p<0.01). Los pacientes derivados por el servicio de cirugía cardiovascular evidenciaron menos oportunidad de cumplir el 80% de las sesiones prescritas [AOR: 0.41 (IC de 0.17 a 0.98), p = 0.047] al ser comparados con aquellos que recibieron prescripción por parte del servicio de cardiología y otras especialidades. En conclusión, los sujetos sometidos a revascularización miocárdica quirúrgica presentaron una mayor oportunidad de participar en el PRC de LCHUB, no obstante, este mismo grupo de pacientes evidenciaron menor oportunidad de cumplimiento del 80% de las sesiones prescritas.Cardiovascular Diseases (CVD) are the leading cause of mortality worldwide. Cardiac Rehabilitation (CR) has proven effective in preventing complications and improving cardiovascular function in patients who have undergone myocardial revascularization. The aim of this study was to determine the factors associated with participation and adherence to the Phase 2 CR program at Los Comuneros Hospital Universitario of Bucaramanga (LCHUB) for patients revascularized between January and December 2022. A retrospective cohort study was conducted on 169 clinical records of patients who underwent coronary revascularization at LCHUB and were attended by the CR program during the study period. Simple and multivariate logistic regressions were performed, with the dependent variable being participation and adherence to 80% of the CR program (CRP). The median age of the patients studied was 64 years, with the majority being men (78%). No significant differences were observed between men and women regarding participation and adherence to CRP. The opportunity for participation in the CRP was greater in patients who underwent bypass surgery compared to those who received percutaneous intervention (p<0.01). Patients referred by the cardiovascular surgery service showed less opportunity to meet the 80% of prescribed sessions [AOR: 0.41 (CI: 0.17 to 0.98), p = 0.047] compared to those who received prescriptions from the cardiology service and other specialties. Patients who underwent bypass surgery had greater opportunity to participate in the CRP at LCHUB, but this group of patients showed a lower opportunity to meet the 80% adherence to the prescribed sessions.EspecializaciónEspecialista en Medicina InternaUniversidad de SantanderIntroducción 17 Planteamiento del Problema 20 Pregunta de Investigación 22 Justificación 23 Objetivos 25 Objetivo General 25 Específicos 25 Marco Referencial 26 Marco Teórico 26 Definición y Epidemiología de las Enfermedades Cardiovasculares 26 Factores de Riesgo Cardiovasculares 27 Definición y Epidemiología del Síndrome Coronario Agudo (SCA) 28 Rehabilitación Cardíaca 31 Fases de la Rehabilitación Cardiaca 33 Fase I. 33 Fase II. 33 Fase III. 34 Fase IV. 34 Indicaciones y Contraindicaciones de la RC 34 Indicaciones de la Rehabilitación Cardíaca. 34 Contraindicaciones Absolutas. 34 Contraindicaciones Relativas. 35 Beneficios de la RC 35 Concepto de Participación 36 Concepto de Adherencia 36 Factores Asociados a Adherencia a PRC 36 Barreras Para Acceder a la RC 39 Estrategias Para Mejorar las Barreras 40 Marco Contextual 41 Marco Legal 42 Consejo Iberoamericano de RC y Prevención Secundaria 42 Marco Legal Nacional 43 Metodología 45 Tipo de Estudio 45 Población y Muestra 45 Criterios de Elegibilidad 45 Inclusión 45 Exclusión 46 Variables 46 Variables Sociodemográficas. 46 Variables Clínicas. 46 Variables de Cumplimiento 46 Participación 46 Adherencia o Cumplimiento al Tratamiento 46 Procedimientos 47 Análisis Estadístico 47 Consideraciones Éticas 48 Resultados 49 Descripción de las Submuestras de Estudio 49 Descripción de las Submuestras de Estudio por Sexo 50 Porcentaje de Participación y Adherencia 51 Factores Asociados a Participación en PRC 52 Análisis Bivariado 52 Análisis Multivariado 53 Factores Asociados a la Participación de los Hombres en los PRC 54 Factores Asociados a la Participación de las Mujeres en los PRC 55 Factores Asociados al Cumplimiento del 80% de la Adherencia en los PRC de Pacientes Revascularizados por SCA 56 Análisis Bivariado 56 Análisis Multivariado 58 Factores Asociados a la Adherencia Superior al 80% en Hombres 59 Factores Asociados a la Adherencia Superior al 80% en Mujeres 60 Discusión 62 Conclusión 69 Referencias Bibliográficas 70 Apéndices 8588 papplication/pdfapplication/mswordUniversidad de SantanderT 104.25 B125fRepositorio Digital Institucional Universidad de Santanderhttps://repositorio.udes.edu.cohttps://repositorio.udes.edu.co/handle/001/11604spaUniversidad de SantanderBucaramangaFacultad de Ciencias Médicas y de la SaludBucaramanga, ColombiaEspecialización en Medicina InternaDalal HM, Doherty P, Taylor RS. 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Al consultar y hacer uso de este recurso, está aceptando las condiciones de uso establecidas por los autores.https://repositorio.udes.edu.coRepositorio Universidad de 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