Goyal Parag, Delgado Diana, Hummel Scott L, Dharmarajan Kumar
Chief Fellow, Division of Cardiology, Weill Cornell Medicine, 525 East 68 Street, New York, NY 10021, USA, , ,
Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA.
Curr Cardiovasc Risk Rep. 2016 Oct;10(10). doi: 10.1007/s12170-016-0514-5. Epub 2016 Sep 9.
Given persistently high 30-day readmission rates among patients hospitalized for heart failure, there is an ongoing need to identify new interventions to reduce readmissions. Although exercise programs can improve outcomes among ambulatory heart failure patients, it is not clear whether this benefit extends to reducing readmissions following heart failure hospitalization. We therefore conducted a systematic review of the literature to identify randomized controlled trials examining the impact of exercise programs on hospital readmissions among patients recently hospitalized for heart failure. We searched Ovid MEDLINE, EMBASE, and the Wiley Cochrane Library for studies that fulfilled pre-defined criteria, including that the exercise program pre-specify activity type and exercise frequency, duration, and intensity. Exercise interventions could occur at any location including within the hospital, at an outpatient facility, or at home. Among 1213 unique publications identified, only one study fulfilled inclusion criteria. This study was a single-site randomized controlled trial that consisted of a 12-week exercise program in a cohort of 105 patients with a principal diagnosis of HF at a metropolitan hospital in Australia. This study revealed a reduction in 12-month all-cause and cardiovascular-related hospitalization rates. However, inferences were limited by its single-site study design, small sample size, premature termination, and high risk for selection, performance, and detection bias. As no studies have built upon the findings of this study, it remains unknown whether exercise programs can improve readmission rates among patients recently hospitalized for heart failure, a significant gap in the literature.
鉴于因心力衰竭住院的患者30天再入院率持续居高不下，持续需要确定新的干预措施以降低再入院率。尽管运动项目可以改善非卧床心力衰竭患者的预后，但尚不清楚这种益处是否能延伸至降低心力衰竭住院后的再入院率。因此，我们对文献进行了系统综述，以确定随机对照试验，这些试验研究了运动项目对近期因心力衰竭住院的患者医院再入院率的影响。我们在Ovid MEDLINE、EMBASE和Wiley Cochrane图书馆中检索符合预定义标准的研究，包括运动项目预先指定活动类型、运动频率、持续时间和强度。运动干预可在任何地点进行，包括医院内、门诊设施或家中。在识别出的1213篇独特出版物中，只有一项研究符合纳入标准。这项研究是一项单中心随机对照试验，在澳大利亚一家大都市医院对105例主要诊断为心力衰竭的患者进行了为期12周的运动项目。这项研究显示12个月全因和心血管相关住院率有所降低。然而，其推论受到单中心研究设计、样本量小、提前终止以及选择、实施和检测偏倚高风险的限制。由于没有研究以该研究结果为基础，运动项目是否能改善近期因心力衰竭住院患者的再入院率仍不清楚，这是文献中的一个重大空白。
