Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia.
Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia.
JACC Heart Fail. 2018 Feb;6(2):143-152. doi: 10.1016/j.jchf.2017.11.016.
This study sought to measure the impact on all-cause death or readmission of adding center-based exercise training (ET) to disease management programs for patients with a recent acute heart failure (HF) hospitalization.
ET is recommended for patients with HF, but evidence is based mainly on ET as a single intervention in stable outpatients.
A randomized, controlled trial with blinded outcome assessor, enrolling adult participants with HF discharged from 5 hospitals in Queensland, Australia. All participants received HF-disease management program plus supported home exercise program; intervention participants were offered 24 weeks of supervised center-based ET. Primary outcome was all-cause 12-month death or readmission. Pre-planned subgroups included age (<70 years vs. older), sex, left ventricular ejection fraction (≤40% vs. >40%), and exercise adherence.
Between May 2008 and July 2013, 278 participants (140 intervention, 138 control) were enrolled: 98 (35.3%) age ≥70 years, 71 (25.5%) females, and 62 (23.3%) with a left ventricular ejection fraction of >40%. There were no adverse events associated with ET. There was no difference in primary outcome between groups (84 of 140 [60.0%] intervention vs. 90 of 138 [65.2%] control; p = 0.37), but a trend toward greater benefit in participants age <70 years (OR: 0.56 [95% CI: 0.30 to 1.02] vs. OR: 1.56 [95% CI: 0.67 to 3.64]; p for interaction = 0.05). Participants who exercised to guidelines (72 of 101 control and 92 of 117 intervention at 3 months) had a significantly lower rate of death and readmission (91 of 164 [55.5%] vs. 41 of 54 [75.9%]; p = 0.008).
Supervised center-based ET was a safe, feasible addition to disease management programs with supported home exercise in patients recently hospitalized with acute HF, but did not reduce combined end-point of death or readmission. (A supervised exercise programme following hospitalisation for heart failure: does it add to disease management?; ACTRN12608000263392).
本研究旨在评估为近期急性心力衰竭（HF）住院患者提供以中心为基础的运动训练（ET）对全因死亡或再入院的影响。
ET 推荐用于 HF 患者，但证据主要基于 ET 作为稳定门诊患者的单一干预措施。
这是一项在澳大利亚昆士兰州 5 家医院进行的、采用随机、对照、设盲结局评估者的临床试验，纳入从这些医院出院的 HF 成年患者。所有患者均接受 HF 疾病管理计划加支持的家庭运动计划；干预组患者还接受 24 周的监督中心为基础的 ET。主要结局为全因 12 个月死亡或再入院。预先计划的亚组包括年龄（<70 岁与≥70 岁）、性别、左心室射血分数（≤40%与>40%）和运动依从性。
2008 年 5 月至 2013 年 7 月，共纳入 278 名参与者（140 名干预组，138 名对照组）：98 名（35.3%）年龄≥70 岁，71 名（25.5%）女性，62 名（23.3%）左心室射血分数>40%。ET 无不良事件。两组间主要结局无差异（干预组 84 例[60.0%]，对照组 90 例[65.2%]；p=0.37），但年龄<70 岁的患者获益更大（OR：0.56[95%CI：0.30 至 1.02]，与 OR：1.56[95%CI：0.67 至 3.64]；p 交互作用=0.05）。在 3 个月时达到运动指南的参与者（对照组 101 例中的 72 例和干预组 117 例中的 92 例）死亡率和再入院率显著降低（对照组 164 例中的 91 例[55.5%]，与干预组 54 例中的 41 例[75.9%]；p=0.008）。
在接受 HF 疾病管理计划加支持的家庭运动的患者中，监督中心为基础的 ET 是安全且可行的，可作为急性 HF 住院患者的附加治疗方法，但不能降低全因死亡或再入院的复合终点。（一项针对心力衰竭患者住院后的监督运动计划：它是否增加了疾病管理？；ACTRN12608000263392）
