Reibis Rona, Jannowitz Christina, Halle Martin, Pittrow David, Gitt Anselm, Völler Heinz
Department of Cardiology, Klinik am See , Rüdersdorf , Germany.
Curr Med Res Opin. 2015 Feb;31(2):211-9. doi: 10.1185/03007995.2014.977854. Epub 2014 Oct 29.
We aimed to describe the contemporary management of patients with systolic chronic heart failure (CHF) during a cardiac rehabilitation (CR) stay and present outcomes with focus on lipids, blood pressure, exercise capacity, and clinical events.
Comparison of 3199 patients with moderately or severely impaired left ventricular ejection fraction (low EF, 13.3%) and 20,913 patients with slightly reduced or normal LVEF (normal EF, 86.7%) who underwent an inpatient CR period of about 3 weeks in 2009-2010.
Patients with low EF compared to those with normal EF were somewhat older (65.1 vs. 63.0 years, p < 0.0001), and more often had risk factors such as diabetes mellitus (39.7% vs. 32.0%, p < 0.0001) or other comorbidities. The overall rate of patients with regular physical activity of at least 90 minutes per week prior to CR was low overall (54.4%), and reduced in patients with low EF compared to those with normal EF (47.7% vs. 55.5%, p < 0.0001). The rate of patients that achieved lower LDL cholesterol (<100 mg/dl), total cholesterol (<200 mg/dl) and triglyceride (<150 mg/dl) values at discharge increased compared to baseline. Mean blood pressure was substantially lower in the low EF group compared to the normal EF group both at baseline (124/75 vs. 130/78 mmHg, p < 0.0001) and at discharge (119/72 vs. 124/74 mmHg, p < 0.0001). Maximum exercise improved substantially in both groups (at baseline 71 vs. 91 Watts, p < 0.0001; at discharge 85 vs. 105 Watts, p < 0.0001). Event rates during CR were low, and only 0.3% in the low EF group died. As limitations to this study, information on brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro BNP) and/or cardiac troponin were not documented, and no long-term information was collected beyond the 3-week CR stay.
Patients with CHF account for a considerable proportion of patients in CR. Also patients with moderate/severe EF benefited from participation in CR, as their lipid profile and physical fitness improved.
我们旨在描述收缩性慢性心力衰竭（CHF）患者在心脏康复（CR）住院期间的当代管理情况，并重点介绍血脂、血压、运动能力和临床事件方面的结果。
比较了2009年至2010年期间接受约3周住院CR治疗的3199例左心室射血分数中度或重度受损（低EF，13.3%）患者和20913例左心室射血分数轻度降低或正常（正常EF，86.7%）患者。
与正常EF患者相比，低EF患者年龄稍大（65.1岁对63.0岁，p<0.0001），且更常患有糖尿病（39.7%对32.0%，p<0.0001）等危险因素或其他合并症。CR前每周进行至少90分钟规律体育活动的患者总体比例较低（54.4%），与正常EF患者相比，低EF患者的这一比例降低（47.7%对55.5%，p<0.0001）。出院时低密度脂蛋白胆固醇（<100mg/dl）、总胆固醇（<200mg/dl）和甘油三酯（<150mg/dl）值达到较低水平的患者比例与基线相比有所增加。低EF组的平均血压在基线时（124/75对130/78mmHg，p<0.0001）和出院时（119/72对124/74mmHg，p<0.0001）均显著低于正常EF组。两组的最大运动能力均有显著改善（基线时71对91瓦，p<0.oo01；出院时85对105瓦，p<0.0001）。CR期间的事件发生率较低，低EF组仅有0.3%的患者死亡。本研究的局限性在于，未记录脑钠肽（BNP）、N末端脑钠肽前体（NT-pro BNP）和/或心肌肌钙蛋白的信息，且在3周CR住院期之后未收集长期信息。
CHF患者在CR患者中占相当比例。中度/重度EF患者也从参与CR中获益，因为他们的血脂状况和身体素质得到了改善。
