Kang Youjeong, Steele Bonnie G, Burr Robert L, Dougherty Cynthia M
1 University of Utah School of Nursing, Salt Lake City, UT, USA.
2 Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA.
Biol Res Nurs. 2018 Jul;20(4):429-439. doi: 10.1177/1099800418772346. Epub 2018 Apr 29.
Cardiopulmonary rehabilitation (CR) improves physical function and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) and heart failure (HF), but it is unknown if CR improves outcomes in very severe disease. This study's purpose was to describe functional capacity (6-min walk distance [6MWD], steps/day), symptoms (dyspnea, depression), QoL (Short-Form Health Survey-Veterans [SF-36 V]) and cardiopulmonary function ( N-terminal pro-brain natriuretic peptide [NT-proBNP], forced expiratory volume in 1 s [FEV]), and derive predictors of mortality among patients with severe COPD and HF who participated in CR.
In this secondary analysis of a randomized controlled trial comparing two CR methods in severe COPD and HF, 90 (COPD = 63, HF = 27) male veterans, mean age 66 ± 9.24 years, 79% Caucasian, and body mass index 31 kg/m, were followed for 12 months after CR. The COPD group had greater functional decline than the HF group (6MWD, p = .006). Dyspnea was lower ( p = .001) and QoL higher ( p = .006) in the HF group. Mean NT-proBNP was higher in the HF group at all time points. FEV improved over 12 months in both groups ( p = .01). Mortality was 8.9%, 16.7%, and 37.8% at 12, 24, and 60 months, respectively. One-year predictors of mortality were baseline total steps (<3,000/day), 6MWD (<229 meters), and NT-proBNP level (>2,000 mg/pg).
In very severe COPD and HF, risks of mortality over 12 months can predict patients unlikely to benefit from CR and should be considered at initial referral.
心肺康复（CR）可改善慢性阻塞性肺疾病（COPD）和心力衰竭（HF）患者的身体功能和生活质量（QoL），但CR对极重度疾病患者预后的改善情况尚不清楚。本研究的目的是描述功能能力（6分钟步行距离[6MWD]、每日步数）、症状（呼吸困难、抑郁）、生活质量（退伍军人简明健康调查问卷[SF-36 V]）和心肺功能（N末端脑钠肽前体[NT-proBNP]、第1秒用力呼气量[FEV]），并推导参与CR的重度COPD和HF患者的死亡率预测因素。
在一项比较两种CR方法治疗重度COPD和HF的随机对照试验的二次分析中，对90名男性退伍军人（COPD = 63例，HF = 27例）进行了研究，他们的平均年龄为66±9.24岁，79%为白种人，体重指数为31kg/m²，在CR后随访12个月。COPD组的功能下降比HF组更明显（6MWD，p = 0.006）。HF组的呼吸困难程度较低（p = 0.001），生活质量较高（p = 0.006）。HF组在所有时间点的平均NT-proBNP均较高。两组的FEV在12个月内均有所改善（p = 0.01）。12个月、24个月和60个月时的死亡率分别为8.9%、16.7%和37.8%。死亡率的1年预测因素为基线总步数（<3000步/天）、6MWD（<229米）和NT-proBNP水平（>2000mg/pg）。
在极重度COPD和HF中，12个月内的死亡风险可预测不太可能从CR中获益的患者，在初次转诊时应予以考虑。
