拒绝心力衰竭 打造强健心脏之路

Mr. Cloutier had quadruple bypass surgery in 2000. He also had a defibrillator implanted in 2003 and a pacemaker put in three years ago. Since then, he has avoided being admitted to the hospital, an accomplishment he and Dr. Ades attribute to his regular physical activity. Until recently, Mr. Cloutier, a nonsmoker, organized regular 20-to-40-mile bicycle trips in the Vermont countryside. Last year, though, his heart-failure symptoms caught up with him and he said he was able to ride only 3 miles. He's hoping to get that to 5 to 10 miles weekly this summer. And he keeps up his rehab regimen, currently 20-minute treadmill sessions at 3 miles an hour and using a weight machine two to three times a week. On other days, he goes on 1 mile walks.
克卢捷在2000年实施了冠状动脉搭桥术，后在2003年植入了一个心脏除颤器，三年前他又安了一个心脏起搏器。自那以后，他一直没有住过院，他和埃兹医生将这一成绩归功于定期的体育锻炼。直到不久前，不吸烟的克卢捷还一直定期组织在佛蒙特乡村骑自行车，每次骑20至40英里。然而，去年他出现了心力衰竭症状，他说他只能骑三英里了。他希望在今年夏天实现每周骑行五至10英里的目标。此外，他还坚持进行心脏康复治疗，目前是以每小时三英里的速度在跑步机上跑20分钟，并使用力量训练器械进行锻炼，频率为每周两到三次。在其他日子里，他会散一英里的步。

'The heart is a muscle,' he said. 'If you don't exercise it and keep it in reasonable shape then it's going to deteriorate and give you problems. That's why I keep going back.'
克卢捷说：“心脏是一团肌肉，如果你不锻炼它，使它一直处于良好的状况，接下来它就会变衰弱，给你带来麻烦。那就是我一直参加锻炼的原因。”

The Medicare decision extends coverage to patients whose heart-pumping function is compromised to a specific level and who have certain heart-failure symptoms despite being on an optimal drug therapy for at least six weeks. It offers one course of 36 sessions for up to 36 weeks, though two- or three-times-a-week sessions are optimal. Patients could apply for a second course of rehab, but generally, they would have to pay out of pocket after completing the first course.
“医疗保险计划”的新规定将偿付范围扩大到心脏泵血功能减弱到某个水平，在进行了至少六周最佳药物治疗后仍出现某些心力衰竭症状的患者。它提供一个包含36次康复训练的疗程，最长可持续36周，但每周两到三次训练的疗程最佳。患者可申请报销第二个康复疗程的费用，但一般说来在完成第一个疗程后他们得自己掏腰包。

The new decision affects about 50% of patients with chronic heart failure. Medicare officials said more data are need to determine whether cardiac rehab will benefit the others, who have a different form of the condition.
新规定影响了50%左右的心力衰竭患者。“医疗保险计划”官员称，其余的患者病症不同，要确定心脏康复是否有利于这些患者，还需研究更多数据。

Doctors expect the trigger for coverage for many patients will be their first hospital admission for heart failure. At that time, doctors would discuss starting an exercise program with a patient after six weeks on medications.
医生预计，许多患者因心力衰竭第一次住院治疗时，就有可能纳入康复报销计划。在那时，医生会在六周的药物治疗后与患者讨论开始锻炼计划。

The first episode 'is your teachable moment,' said Mariell Jessup, a heart failure doctor at University of Pennsylvania and president of the American Heart Association. Upon hearing the diagnosis, people think it is a death sentence. 'We say, 'you're not going to die. We're going to work on you living.'
宾夕法尼亚大学(University of Pennsylvania)心力衰竭医生、AHA主席玛丽埃尔·杰瑟普(Mariell Jessup)称，第一阶段“是你可施教的时机。”一听到诊断结果后，人们就会觉得自己被判了死刑。杰瑟普说：“我们会告诉他们，‘你不会死的，我们会努力让你活下去。”