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经导管主动脉瓣置换术后的住院心脏康复与临床疗效及生活质量改善相关。

Inpatient Cardiac Rehabilitation after Transcatheter Aortic Valve Replacement Is Associated with Improved Clinical Performance and Quality of Life.

作者信息

Kleczynski Pawel, Trebacz Jaroslaw, Stapor Maciej, Sobczynski Robert, Konstanty-Kalandyk Janusz, Kapelak Boguslaw, Zmudka Krzysztof, Legutko Jacek

机构信息

Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland.

Department of Cardiac and Vascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland.

出版信息

J Clin Med. 2021 May 14;10(10):2125. doi: 10.3390/jcm10102125.

Abstract

Cardiac rehabilitation (CR) provides multifactorial support and intervention for cardiac patients and improves quality of life (QoL). We aimed to assess clinical performance and QoL changes in patients undergoing transcatheter aortic valve replacement (TAVR) scheduled directly to inpatient CR (CR group) and those who were discharged home (DH group). The following patient-related outcomes were recorded: 5 m walk time (5MWT), 6 min walk test (6MWT), handgrip strength (HGS) with dynamometer, Katz index of Independence of Activities in Daily Living (KI of ADL), Hospital Anxiety and Depression Scores (HADS) Score. Quality of life was evaluated with Kansas City Cardiomyopathy Questionnaire (KCCQ). Baseline data, 30-day and 6- and 12-month data were assessed. The CR group consisted of 52 patients and 53 were in the discharged home (DH group). When we compared outcomes between the groups, the 5MWT, 6MWT, HGS KI of ADL, and KCCQ were significantly better in the CR group at 30 days ( = 0.03, = 0.01, = 0.02, = 0.048, respectively), and no difference was found in HADS scores. At 6 months, the effect of CR was sustained for 6MWT, HGS, KI of ADL, and KCCQ ( = 0.001, = 0.001, = 0.03, = 0.003, respectively) but not for 5MWT. Interestingly, at 12 months, the CR group had better performance only in 6MWT and HGS compared with the DH group ( = 0.04, = 0.03, respectively). We showed that inpatient CR is strongly associated with better clinical performance and QoL in patients undergoing TAVR. All patients may benefit from CR after TAVR. The most important aspect of inpatient CR after TAVR from the patient's perspective may be better performance in daily activities; however, performance was attenuated after 1 year.

摘要

心脏康复(CR)为心脏病患者提供多方面的支持和干预,并改善生活质量(QoL)。我们旨在评估直接安排住院心脏康复(CR组)的经导管主动脉瓣置换术(TAVR)患者和出院回家(DH组)患者的临床状况及生活质量变化。记录了以下与患者相关的结果:5米步行时间(5MWT)、6分钟步行试验(6MWT)、握力计测量的握力(HGS)、日常生活活动能力的Katz独立性指数(ADL的KI)、医院焦虑和抑郁评分(HADS评分)。使用堪萨斯城心肌病问卷(KCCQ)评估生活质量。评估了基线数据、30天以及6个月和12个月的数据。CR组有52例患者,出院回家组(DH组)有53例患者。当我们比较两组之间的结果时,CR组在30天时的5MWT、6MWT、HGS、ADL的KI和KCCQ显著更好(分别为P = 0.03、P = 0.01、P = 0.02、P = 0.048),而HADS评分无差异。在6个月时,CR对6MWT、HGS、ADL的KI和KCCQ的影响持续存在(分别为P = 0.001、P = 0.001、P = 0.03、P = 0.003),但对5MWT没有影响。有趣的是,在12个月时,与DH组相比,CR组仅在6MWT和HGS方面表现更好(分别为P = 0.04、P = 0.03)。我们表明,住院心脏康复与接受TAVR的患者更好的临床状况和生活质量密切相关。所有患者在TAVR后都可能从心脏康复中受益。从患者角度来看,TAVR后住院心脏康复最重要的方面可能是日常活动表现更好;然而,1年后这种表现有所减弱。

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