University of Louisville School of Medicine, Louisville, Kentucky.
University of Texas Southwestern Medical Center, Dallas, Texas.
J Am Coll Cardiol. 2015 Aug 25;66(8):917-26. doi: 10.1016/j.jacc.2015.06.1089.
Current guidelines recommend cardiac rehabilitation (CR) in medically stable outpatients with heart failure (HF); however, temporal trends and factors associated with CR referral among these patients in real-world practice are not entirely known.
The purpose of this study was to assess proportional use, temporal trends, and factors associated with CR referral at discharge among patients admitted with decompensated HF.
Using data from a national Get With the Guidelines-Heart Failure registry, we assessed the temporal trends in CR referral among eligible patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) at discharge after HF hospitalization between 2005 and 2014. On multivariable analysis, we also assessed patient- and hospital-level characteristics that are associated with CR referral.
Among 105,619 HF patients (48% with HFrEF, 52% with HFpEF), 10.4% (12.2% with HFrEF, 8.8% with HFpEF) received CR referral at discharge. A significant increase in CR referral rates was observed among both HFpEF and HFrEF patients over the study period (ptrend <0.0001 for HFrEF, HFpEF, and overall). Compared with patients discharged without CR referral, patients referred for CR were younger, predominantly men, and more likely to receive evidence-based HF therapies at discharge. On multivariable analysis, younger age, fewer comorbid conditions, and in-hospital procedures such as coronary artery bypass grafting, percutaneous coronary intervention, and cardiac valve surgery were most strongly associated with CR referral.
Only one-tenth of eligible HF patients received CR referral at discharge after hospitalization for HF. The proportional use of CR referral is increasing over time among both HFrEF and HFpEF patients. Further strategies to improve physician and patient awareness in regard to the benefit of CR should be used to increase CR referral among patients with HF.
目前的指南建议将心脏康复(CR)用于患有心力衰竭(HF)的医学稳定门诊患者;然而,在实际实践中,这些患者接受 CR 转介的时间趋势和相关因素并不完全清楚。
本研究旨在评估失代偿性 HF 住院患者出院时 CR 转介的比例使用、时间趋势和相关因素。
使用来自全国 Get With the Guidelines-Heart Failure 注册中心的数据,我们评估了 2005 年至 2014 年期间,HF 射血分数降低(HFrEF)和 HF 射血分数保留(HFpEF)患者在 HF 住院后出院时 CR 转介的时间趋势。在多变量分析中,我们还评估了与 CR 转介相关的患者和医院特征。
在 105619 例 HF 患者中(48%为 HFrEF,52%为 HFpEF),有 10.4%(12.2%为 HFrEF,8.8%为 HFpEF)在出院时接受了 CR 转介。在研究期间,HFpEF 和 HFrEF 患者的 CR 转介率均显著增加(HFrEF、HFpEF 和总体趋势均<0.0001)。与未接受 CR 转介的患者相比,接受 CR 转介的患者年龄较小,主要为男性,并且更有可能在出院时接受循证 HF 治疗。在多变量分析中,年龄较小、合并症较少以及住院期间的程序(如冠状动脉旁路移植术、经皮冠状动脉介入治疗和心脏瓣膜手术)与 CR 转介最密切相关。
只有十分之一的符合条件的 HF 患者在 HF 住院后出院时接受了 CR 转介。在 HFrEF 和 HFpEF 患者中,CR 转介的比例随着时间的推移而增加。应采取进一步的策略来提高医生和患者对 CR 益处的认识,以增加 HF 患者的 CR 转介率。