Giallauria Francesco, Fattirolli Francesco, Tramarin Roberto, Ambrosetti Marco, Griffo Raffaele, Riccio Carmine, Vigorito Carlo
aDepartment of Clinical Medicine, Cardiovascular and Immunological Sciences, Cardiac Rehabilitation Unit, University of Naples 'Federico II', Naples, Italy bDepartment of Critical Care Medicine and Surgery, Cardiac Rehabilitation Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence (FI), Italy cDivision of Cardiac Rehabilitation, Fondazione Europea di Ricerca Biomedica, Cernusco S/N (MI), Italy dClinica 'Le Terrazze', Cunardo (VA), Italy eDepartment of Cardiology, Cardiac Rehabilitation Unit, La Colletta Hospital, Arenzano (GE), Italy fAzienda Ospedaliera S. Anna e S. Sebastiano di Caserta, Caserta (CE), Italy.
J Cardiovasc Med (Hagerstown). 2014 Feb;15(2):155-63. doi: 10.2459/JCM.0b013e3283620533.
Using data from the Italian SurveY on carDiac rEhabilitation (ISYDE-2008), this study provides insight into the level of implementation of cardiac rehabilitation in patients with chronic heart failure (CHF).
Data from 165 Italian cardiac rehabilitation units were collected online from 28 January to 10 February 2008.
The study cohort consisted of 2281 patients (66.9 ± 11.8 years): 285 (71.3 ± 12.2 years, 66% male) CHF patients and 1996 (66.3 ± 11.6 years, 74% male) non-CHF patients. Compared with non-CHF, CHF patients were older, showed more comorbidity, had lower left ventricular (LV) ejection fraction and reduced access to functional evaluation, underwent more complications during cardiac rehabilitation, and had longer length of in-hospital stay. CHF patients were also more likely to be transferred to ICU (9 versus 3%, P < 0.0001), and less likely to be discharged home (85 versus 92%, respectively, P < 0.0001). Also, discharge prescriptions were significantly different from those of non-CHF patients. Finally, CHF patients had higher mortality during cardiac rehabilitation (1.7 versus 0.5%, P = 0.01). After adjusting for age, ejection fraction, comorbidity, previous interventions and complications during cardiac rehabilitation, multivariate logistic analysis showed that not performing any of the physical performance tests [odds ratio (OR) = 7.0, 95% confidence interval (CI), 1.9-25.8, P = 0.003], acute respiratory failure (OR = 2.3, 95% CI, 1.3-4.1, P = 0.002), acute kidney insufficiency or worsening of chronic kidney disease (OR = 2.9, 95% CI, 1.5-5.6, P = 0.001) and worsening of cognitive impairment (OR = 3.7, 95% CI, 2.0-6.7, P < 0.001) were significant predictors of death in CHF patients.
The ISYDE-2008 survey provided a detailed snapshot of cardiac rehabilitation in CHF patients, and confirmed the complexity and the more severe clinical course of these patients during cardiac rehabilitation.
本研究利用意大利心脏康复调查（ISYDE - 2008）的数据，深入了解慢性心力衰竭（CHF）患者心脏康复的实施水平。
2008年1月28日至2月10日通过网络收集了来自165个意大利心脏康复单位的数据。
研究队列包括2281例患者（66.9±11.8岁）：285例CHF患者（71.3±12.2岁，66%为男性）和1996例非CHF患者（66.3±11.6岁，74%为男性）。与非CHF患者相比，CHF患者年龄更大，合并症更多，左心室（LV）射血分数更低，功能评估机会更少，心脏康复期间发生更多并发症，住院时间更长。CHF患者也更有可能被转入重症监护病房（9%对3%，P<0.0001），出院回家的可能性更小（分别为85%对92%，P<0.0001）。此外，出院处方与非CHF患者有显著差异。最后，CHF患者在心脏康复期间的死亡率更高（1.7%对0.5%，P = 0.01）。在对年龄、射血分数、合并症、既往干预措施以及心脏康复期间的并发症进行校正后，多因素逻辑分析显示，未进行任何体能测试[比值比（OR）=7.0，95%置信区间（CI），1.9 - 25.8，P = 0.003]、急性呼吸衰竭（OR = 2.3，95%CI，1.3 - 4.1，P = 0.002）、急性肾功能不全或慢性肾病恶化（OR = 2.9，95%CI，1.5 - 5.6，P = 0.001）以及认知障碍恶化（OR = 3.7，95%CI，2.0 - 6.7，P<0.001）是CHF患者死亡的显著预测因素。
ISYDE - 2008调查提供了CHF患者心脏康复的详细概况，并证实了这些患者在心脏康复期间临床过程的复杂性和更严重性。
