Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain.
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain.
Am J Med. 2021 Mar;134(3):383-390.e2. doi: 10.1016/j.amjmed.2020.09.019. Epub 2020 Oct 24.
Older adult patients with frailty are rarely involved in rehabilitation programs after myocardial infarction. Our aim was to investigate the benefits of exercise intervention in these patients.
A total of 150 survivors after acute myocardial infarction, ≥70 years and with pre-frailty or frailty (Fried scale ≥1 points), were randomized to control (n = 77) or intervention (n = 73) groups. The intervention consisted of a 3-month exercise program, under physiotherapist supervision, followed by an independent home-based program. The main outcome was frailty (Fried scale) at 3 months and 1 year. Secondary endpoints were clinical events (mortality or any readmission) at 1 year.
Mean age was 80 years (range = 70-96). In the intervention group, 44 (60%) out of 73 patients participated in the program and 23 (32%) completed it. Overall, there was a decrease in the Fried score in the intervention group at 3 months, with no effect at 1 year. However, in the intention-to-treat analysis, such change did not achieve statistical significance (P = 0.110). Only treatment comparisons made among the subgroups that participated in (P = 0.033) and completed (P = 0.018) the program achieved statistical significance. There were no differences in clinical events. Worse Fried score trajectory along follow-up increased mortality risk (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.24-4.55, P = 0.009) CONCLUSIONS: Recruitment and retention for a physical program in older adult patients with frailty after myocardial infarction was challenging. Frailty status improved in the subgroup that participated in the program, although this benefit was attenuated after shifting to a home-based program. A better frailty trajectory might influence midterm prognosis. (ClinicalTrials.govNCT02715453).
虚弱的老年心肌梗死后患者很少参与康复计划。我们的目的是研究运动干预对这些患者的益处。
共有 150 名急性心肌梗死后≥70 岁且有虚弱前期或虚弱（弗里德量表≥1 分）的幸存者被随机分为对照组（n=77）或干预组（n=73）。干预措施包括 3 个月的运动计划，由物理治疗师监督，随后是独立的家庭基础计划。主要结局是 3 个月和 1 年时的虚弱状态（弗里德量表）。次要终点是 1 年时的临床事件（死亡或任何再入院）。
平均年龄为 80 岁（范围为 70-96 岁）。在干预组中，73 名患者中有 44 名（60%）参加了该计划，23 名（32%）完成了该计划。总体而言，干预组在 3 个月时的弗里德评分下降，但在 1 年时没有效果。然而，在意向治疗分析中，这种变化没有达到统计学意义（P=0.110）。只有在参加（P=0.033）和完成（P=0.018）计划的亚组中进行的治疗比较才达到统计学意义。两组在临床事件方面没有差异。随着随访的进行，虚弱评分轨迹的恶化增加了死亡风险（危险比[HR]为 2.38，95%置信区间[CI]为 1.24-4.55，P=0.009）。
在心肌梗死后的老年虚弱患者中招募和保留参加身体锻炼计划具有挑战性。在参加计划的亚组中，虚弱状态得到改善，但在转向家庭基础计划后，这种益处减弱。更好的虚弱轨迹可能会影响中期预后。（临床试验.govNCT02715453）。
