Bravo-Escobar Raquel, González-Represas Alicia, Gómez-González Adela María, Montiel-Trujillo Angel, Aguilar-Jimenez Rafael, Carrasco-Ruíz Rosa, Salinas-Sánchez Pablo
Unidad de Rehabilitación Cardiaca, Hospital universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, 29010, Málaga, España.
Facultad de Fisioterapia, Departamento de Biología Funcional y Ciencias de la Salud, Universidad de Vigo, Campus A Xunqueira s/n, 36005, Pontevedra, España.
BMC Cardiovasc Disord. 2017 Feb 20;17(1):66. doi: 10.1186/s12872-017-0499-0.
Previous studies have documented the feasibility of home-based cardiac rehabilitation programmes in low-risk patients with ischemic heart disease, but a similar solution needs to be found for patients at moderate cardiovascular risk. The objective of this study was to analyse the effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic cardiopathology at moderate cardiovascular risk.
A randomised, controlled clinical trial was designed wherein 28 patients with stable coronary artery disease at moderate cardiovascular risk, who met the selection criteria for this study, participated. Of these, 14 were assigned to the group undergoing traditional cardiac rehabilitation in hospital (control group) and 14 were assigned to the home-based mixed surveillance programme (experimental group). The patients in the experimental group went to the cardiac rehabilitation unit once a week and exercised at home, which was monitored with a remote electrocardiographic monitoring device (NUUBO®). The in-home exercises comprised of walking at 70% of heart rate reserve during the first month, and 80% during the second month, for 1 h per day at a frequency of 5 to 7 days per week. A two-way repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of time (before and after intervention) and time-group interaction regarding exercise capacity, risk profile, cardiovascular complications, and quality of life.
No significant differences were observed between the traditional cardiac rehabilitation group and the home-based with mixed surveillance group for exercise time and METS achieved during the exertion test, and the recovery rate in the first minute (which increased in both groups after the intervention). The only difference between the two groups was for quality of life scores (10.93 [IC95%: 17.251, 3.334, p = 0.007] vs -4.314 [IC95%: -11.414, 2.787; p = 0.206]). No serious heart-related complications were recorded during the cardiac rehabilitation programme.
The home-based cardiac rehabilitation programme with mixed surveillance appears to be as effective and safe as the traditional model in patients with ischemic heart disease who are at moderate cardiovascular risk. However, the cardiac rehabilitation programmes carried out in hospital seems to have better results in improving the quality of life.
Retrospectively registered NCT02796404 (May 23, 2016).
先前的研究已证明，针对低风险缺血性心脏病患者开展居家心脏康复计划是可行的，但对于中度心血管风险患者，仍需找到类似的解决方案。本研究的目的是分析针对中度心血管风险的缺血性心脏病患者的居家混合监测心脏康复计划的有效性和安全性。
设计了一项随机对照临床试验，28名符合本研究入选标准的中度心血管风险稳定型冠状动脉疾病患者参与其中。其中，14名被分配至在医院接受传统心脏康复的组（对照组），14名被分配至居家混合监测计划组（实验组）。实验组患者每周前往心脏康复单元一次，并在家中进行锻炼，通过远程心电图监测设备（NUUBO®）进行监测。居家锻炼包括第一个月以心率储备的70%步行，第二个月以80%步行，每天1小时，每周5至7天。进行双向重复测量方差分析（ANOVA），以评估时间（干预前后）和时间-组交互作用对运动能力、风险状况、心血管并发症和生活质量的影响。
在运动测试期间的运动时间和达到的代谢当量以及第一分钟的恢复率方面，传统心脏康复组与居家混合监测组之间未观察到显著差异（干预后两组均有所增加）。两组之间的唯一差异在于生活质量评分（10.93 [IC95%：17.251, 3.334, p = 0.007] 对比 -4.314 [IC95%：-11.414, 2.787；p = 0.206]）。在心脏康复计划期间未记录到严重的心脏相关并发症。
对于中度心血管风险的缺血性心脏病患者，居家混合监测心脏康复计划似乎与传统模式一样有效且安全。然而，在医院开展的心脏康复计划在改善生活质量方面似乎有更好的效果。
回顾性注册NCT02796404（2016年5月23日）。
