心力衰竭患者的身体功能表现和预后：系统评价和荟萃分析。
Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis.
机构信息
Department of Physiotherapy, Faculty of Health Science, University of Malaga, The Institute of Biomedical Research in Malaga (IBIMA), Clinimetric Group FE-14, Malaga, Spain.
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
出版信息
BMC Cardiovasc Disord. 2020 Dec 9;20(1):512. doi: 10.1186/s12872-020-01725-5.
BACKGROUND
Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. This systematic review and meta-analysis aims to summarise and synthesise the evidence published about the relationship between physical functional performance and prognosis in patients with HF, as well as assess the risk of bias of included studies and the level of evidence per outcome.
METHODS
Major electronic databases, such as PubMed, AMED, CINAHL, EMBASE, PEDro, Web of Science, were searched from inception to March 2020 for observational longitudinal cohort studies (prospective or retrospective) examining the relationship between physical functional performance and prognosis in patients with HF.
RESULTS
44 observational longitudinal cohort studies with a total of 22,598 patients with HF were included. 26 included studies reported a low risk of bias, and 17 included studies showed a moderate risk of bias. Patients with poor physical functional performance in the Six Minute Walking Test (6MWT), in the Short Physical Performance Battery (SPPB) and in the Gait Speed Test showed worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance. However, there was a lack of homogeneity regarding which cut-off points should be used to stratify patients with poor physical functional performance from patients with good physical functional performance.
CONCLUSION
The review includes a large number of studies which show a strong relationship between physical functional performance and prognosis in patients with HF. Most of the included studies reported a low risk of bias, and GRADE criteria showed a low and a moderate level of evidence per outcome.
背景
心力衰竭（HF）患者的功能能力受损，这与他们的预后有关。此外，在功能测试中，身体的功能表现也与 HF 患者的预后有关。因此，研究功能测试中的身体功能表现如何能确定 HF 患者的预后将是有用的，因为 HF 是导致 65 岁以上人群住院的主要原因。本系统评价和荟萃分析旨在总结和综合发表的关于 HF 患者身体功能表现与预后之间关系的证据，并评估纳入研究的偏倚风险和每个结局的证据水平。
方法
从开始到 2020 年 3 月，主要电子数据库（如 PubMed、AMED、CINAHL、EMBASE、PEDro、Web of Science）被搜索，以寻找观察性纵向队列研究（前瞻性或回顾性），研究 HF 患者身体功能表现与预后之间的关系。
结果
纳入了 44 项观察性纵向队列研究，共有 22598 例 HF 患者。26 项纳入研究报告了低偏倚风险，17 项纳入研究显示了中度偏倚风险。在 6 分钟步行试验（6MWT）、短体物理性能电池（SPPB）和步态速度试验中身体功能表现较差的患者比身体功能表现较好的患者有更大的住院或死亡风险，预后较差。然而，对于哪些截止点应该用于将身体功能表现较差的患者与身体功能表现较好的患者区分开来，缺乏同质性。
结论
该综述包括大量研究，这些研究表明身体功能表现与 HF 患者的预后之间存在很强的关系。纳入的大多数研究报告了低偏倚风险，GRADE 标准显示每个结局的证据水平为低和中。
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