Bispebjerg Frederiksberg Hospital, University of Copenhagen, Denmark.
Unit of Biostatistics, Department of Statistics, Mathematical Analysis, and Optimization, Universidade de Santiago de Compostela, Spain.
Eur J Prev Cardiol. 2020 May;27(8):811-819. doi: 10.1177/2047487319887835. Epub 2019 Nov 19.
Improvement in exercise capacity is a main goal of cardiac rehabilitation but the effects are often lost at long-term follow-up and thus also the benefits on prognosis. We assessed whether improvement in VO during a cardiac rehabilitation programme predicts long-term prognosis.
We performed a retrospective analysis of 1561 cardiac patients completing cardiac rehabilitation in 2011-2017 in Copenhagen. Mean age was 63.6 (11) years, 74% were male and 84% had coronary artery disease, 6% chronic heart failure and 10% heart valve replacement. The association between baseline VO and improvement after cardiac rehabilitation and being readmitted for cardiovascular disease and/or all-cause mortality was assessed with three different analyses: Cox regression for the combined outcome, for all-cause mortality and a multi-state model. During a median follow-up of 2.3 years, 167 readmissions for cardiovascular disease and 77 deaths occurred. In adjusted Cox regression there was a non-linear decreasing risk of the combined outcome with higher baseline VO and with improvement of VO after cardiac rehabilitation. A similar linear association was seen for all-cause mortality. Applying the multi-state model, baseline VO and change in VO were associated with risk of a cardiovascular disease readmission and with all-cause mortality but not with mortality in those having an intermediate readmission for cardiovascular disease.
VO as well as change in VO were highly predictive of future risk of readmissions for cardiovascular disease and all-cause mortality. The predictive value did not extend beyond the next admission for a cardiovascular event.
提高运动能力是心脏康复的主要目标，但在长期随访中，效果往往会丧失，因此对预后的益处也会丧失。我们评估了心脏康复计划中 VO 的改善是否能预测长期预后。
我们对 2011-2017 年在哥本哈根完成心脏康复的 1561 名心脏患者进行了回顾性分析。平均年龄为 63.6（11）岁，74%为男性，84%患有冠状动脉疾病，6%患有慢性心力衰竭，10%患有心脏瓣膜置换术。使用三种不同的分析方法评估基线 VO 与心脏康复后的改善以及因心血管疾病和/或全因死亡率再次入院之间的关系：用于综合结果的 Cox 回归、用于全因死亡率的 Cox 回归和多状态模型。在中位随访 2.3 年期间，发生了 167 次心血管疾病再入院和 77 例死亡。在调整后的 Cox 回归中，随着基线 VO 的增加和心脏康复后 VO 的改善，综合结果的风险呈非线性降低。全因死亡率也存在类似的线性关联。应用多状态模型，基线 VO 和 VO 的变化与心血管疾病再入院和全因死亡率的风险相关，但与那些有中间心血管疾病再入院的患者的死亡率无关。
VO 及其变化与未来心血管疾病再入院和全因死亡率的风险高度相关。预测价值并未超出下一次心血管事件的入院。
