Department of Health Sciences, University of York, York, UK.
Cardiology department, York Teaching Hospitals NHS Foundation Trust, York, UK.
Open Heart. 2019 Feb 27;6(1):e000866. doi: 10.1136/openhrt-2018-000866. eCollection 2019.
Patients with heart failure (HF) attending cardiac rehabilitation (CR) benefit in terms of improved quality of life, physical fitness and reduced hospital admissions. Too few patients with HF attend CR and little data exist on the characteristics of those who do especially in respect of physical fitness. This study evaluates the extent by which clinical and demographic factors determine walking fitness in patients with a primary diagnosis of HF.
Clinical data from the British Heart Foundation National Audit of Cardiac Rehabilitation identified 1519 patients with HF who completed an incremental shuttle walk test (ISWT). Stepwise regression accounting for age, gender and multiple potential confounders assessed their contribution to total walking distance.
Mean age was 64.5 (SD 12.70) years with a range of ISWT distances across gender and associated comorbidities from 215 to 282 m. Walking distance reduced by 4.9 m for each year increase in age above mean age (p<0.001). After accounting for confounders, females walked 42.1 m less than males (p≤ 0.001). Pulmonary disease and the existence of depression was associated with a 39.3 and 52.2 m reduction in walking distance, respectively. Body mass index >30 was associated with 28.5 m reduction in walking distance (p<0.001). HF severity failed to improve the regression model fit or achieve significance in the analysis.
Age, gender and the presence of pulmonary disease or depression were highly significant factors in predicting walking fitness in patients with HF. The study also produced a set of reference values based on these four factors to aid the interpretation of walking fitness in patients with HF.
接受心脏康复（CR）的心力衰竭（HF）患者在生活质量、身体健康和减少住院方面都有改善。只有很少的 HF 患者参加 CR，关于参加者的特征，尤其是身体健康方面的数据很少。本研究评估了临床和人口统计学因素在多大程度上决定了 HF 患者的步行能力。
英国心脏基金会国家心脏康复审计的临床数据确定了 1519 名完成递增穿梭步行测试（ISWT）的 HF 患者。逐步回归考虑年龄、性别和多个潜在混杂因素，评估它们对总步行距离的贡献。
平均年龄为 64.5（SD 12.70）岁，性别和相关合并症的 ISWT 距离范围为 215 至 282 米。年龄每增加 1 岁，步行距离减少 4.9 米（p<0.001）。在考虑混杂因素后，女性比男性少走 42.1 米（p≤0.001）。肺部疾病和抑郁的存在分别与步行距离减少 39.3 米和 52.2 米相关。BMI>30 与步行距离减少 28.5 米相关（p<0.001）。HF 严重程度未能改善回归模型的拟合度或在分析中达到显著性。
年龄、性别以及肺部疾病或抑郁的存在是预测 HF 患者步行能力的高度重要因素。该研究还根据这四个因素制定了一套参考值，以帮助解释 HF 患者的步行能力。
