Ishikawa Koji, Fukushima Arata, Yokota Takashi, Takada Shingo, Furihata Takaaki, Kakutani Naoya, Yamanashi Katsuma, Obata Yoshikuni, Nakano Ippei, Abe Takahiro, Kinugawa Shintaro, Anzai Toshihisa
Department of Nursing, Hokkaido University of Science Sapporo Japan.
Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Sapporo Japan.
Circ Rep. 2020 Apr 5;1(4):179-186. doi: 10.1253/circrep.CR-18-0022.
In heart failure (HF) management, early ambulation is recommended to prevent physical deconditioning. The effects of delayed ambulation on later clinical outcomes and the factors linked to delayed ambulation in hospitalized HF patients, however, remain unestablished. We retrospectively investigated 101 patients (mean age, 66±17 years) who were hospitalized for acute decompensated HF. During the mean follow-up of 244±15 days after hospital discharge, 34 patients had cardiovascular events leading to death or unplanned readmission. Patients with cardiovascular events had longer median days to acquire ambulation than those without cardiovascular events (11 days, IQR, 8-20 days vs. 7 days, IQR, 5-15 days, P<0.001). The optimal cut-off period until initiation of ambulation to discriminate cardiovascular events was 8 days, indicating that longer days (≥8 days) to acquire ambulation was associated with higher rates of cardiovascular events, even after adjustment of multiple confounders. On multivariate analysis, age >65 years (odds ratio [OR], 2.49; 95% confidence interval [CI]: 1.04-6.09) and increase in blood urea nitrogen (BUN; OR, 1.04; 95% CI: 1.01-1.08) were independent predictors of delayed ambulation. Delayed ambulation is associated with older age and increased BUN in patients with acute HF. Time to ambulation in the recovery phase of acute HF is important, and delayed ambulation may increase the rate of cardiovascular events after hospital discharge.
在心力衰竭（HF）管理中，建议早期下床活动以防止身体机能衰退。然而，延迟下床活动对随后临床结局的影响以及与住院HF患者延迟下床活动相关的因素仍未明确。我们回顾性调查了101例因急性失代偿性HF住院的患者（平均年龄66±17岁）。在出院后平均244±15天的随访期间，34例患者发生了导致死亡或计划外再入院的心血管事件。发生心血管事件的患者获得下床活动的中位天数比未发生心血管事件的患者更长（11天，四分位间距，8 - 20天 vs. 7天，四分位间距，5 - 15天，P<0.001）。区分心血管事件的下床活动起始最佳截止期为8天，这表明即使在调整多个混杂因素后，获得下床活动的天数更长（≥8天）与心血管事件发生率更高相关。多因素分析显示，年龄>65岁（比值比[OR]，2.49；95%置信区间[CI]：1.04 - 6.09）和血尿素氮（BUN）升高（OR，1.04；95%CI：1.01 - 1.08）是延迟下床活动的独立预测因素。急性HF患者延迟下床活动与年龄较大和BUN升高有关。急性HF恢复期的下床活动时间很重要，延迟下床活动可能会增加出院后心血管事件的发生率。
