Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Cardiol. 2020 Apr;36(4):482-489. doi: 10.1016/j.cjca.2019.08.032. Epub 2019 Aug 29.
Cardiac rehabilitation is a mainstay treatment for patients experiencing an adverse cardiovascular event. Heart disease is important in frailty, but the impact of cardiac rehabilitation on frailty is unclear.
Patients were referred to a 12-week group-based exercise and education cardiac rehabilitation program performed twice weekly. Frailty was measured with the use of a 25-item accumulation of deficits frailty index (range 0-1; higher values indicate greater frailty) at cardiac rehabilitation admission and completion. Patients were categorized by the degree of frailty in 0.1 increments.
Of the 4004 patients who enrolled, 2322 (58.0%) completed cardiac rehabilitation with complete data at admission and completion. There were 414 (17.8%), 642 (27.6%), 690 (29.7%), 401 (17.3%), and 175 (7.5%) patients with admission frailty levels of < 0.20, 0.20-0.30, 0.30-0.40, 0.40-0.50, and > 0.50, respectively. Frailty levels improved from cardiac rehabilitation admission (mean 0.34 [95% CI 0.32-0.35]) to completion (0.26 [0.25-0.28]) for those who completed the program (P < 0.001). After adjusting for age, sex, and number of exercise sessions attended, frailty improved in all frailty groups by mean differences of 0.03 (0.02-0.03), 0.05 (0.05-0.06), 0.08 (0.08-0.09), 0.10 (0.09-0.11), and 0.11 (0.10-0.13) in the < 0.20, 0.20-0.30, 0.30-0.40, 0.40-0.50, and > 0.50 frailty groups, respectively. The minimal improvement in frailty scores (≥ 0.03 reduction) was achieved by 48%, 65%, 72%, 76%, and 79% of patients in the the 5 frailty groups, respectively.
Although higher frailty levels were associated with cardiac rehabilitation drop-out, finishing the program was related to improving frailty levels, especially in patients who were the frailest.
心脏康复是经历不良心血管事件患者的主要治疗方法。心脏病在衰弱中很重要，但心脏康复对衰弱的影响尚不清楚。
将患者转介至每周两次进行为期 12 周的基于小组的运动和教育心脏康复计划。在心脏康复入院和完成时，使用 25 项累积缺陷衰弱指数（范围 0-1；值越高表示衰弱程度越高）来衡量衰弱程度。患者按 0.1 增量的衰弱程度进行分类。
在 4004 名入组患者中，有 2322 名（58.0%）完成了心脏康复，入院和完成时均有完整数据。入院时衰弱程度分别为<0.20、0.20-0.30、0.30-0.40、0.40-0.50 和>0.50 的患者分别为 414 例（17.8%）、642 例（27.6%）、690 例（29.7%）、401 例（17.3%）和 175 例（7.5%）。从心脏康复入院（平均 0.34 [95% CI 0.32-0.35]）到完成时（0.26 [0.25-0.28]），完成该计划的患者的衰弱程度有所改善（P < 0.001）。在校正年龄、性别和参加的运动次数后，所有衰弱组的衰弱程度均有改善，平均差异分别为 0.03（0.02-0.03）、0.05（0.05-0.06）、0.08（0.08-0.09）、0.10（0.09-0.11）和 0.11（0.10-0.13），分别在<0.20、0.20-0.30、0.30-0.40、0.40-0.50 和>0.50 衰弱组。在 5 个衰弱组中，分别有 48%、65%、72%、76%和 79%的患者实现了衰弱评分的最小改善（≥0.03 分）。
尽管较高的衰弱水平与心脏康复脱落有关，但完成该计划与改善衰弱水平有关，尤其是在最虚弱的患者中。
