Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom.
Cardiovascular and Metabolic Medicine Institute of Life Course and Medical Sciences University of Liverpool United Kingdom.
J Am Heart Assoc. 2021 Jun 15;10(12):e020804. doi: 10.1161/JAHA.121.020804. Epub 2021 Jun 5.
Background There is limited evidence of long-term impact of exercise-based cardiac rehabilitation (CR) on clinical end points for patients with atrial fibrillation (AF). We therefore compared 18-month all-cause mortality, hospitalization, stroke, and heart failure in patients with AF and an electronic medical record of exercise-based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on February 3, 2021 from a global federated health research network. Patients with AF undergoing exercise-based CR were propensity-score matched to patients with AF without exercise-based CR by age, sex, race, comorbidities, cardiovascular procedures, and cardiovascular medication. We ascertained 18-month incidence of all-cause mortality, hospitalization, stroke, and heart failure. Of 1 366 422 patients with AF, 11 947 patients had an electronic medical record of exercise-based CR within 6-months of incident AF who were propensity-score matched with 11 947 patients with AF without CR. Exercise-based CR was associated with 68% lower odds of all-cause mortality (odds ratio, 0.32; 95% CI, 0.29-0.35), 44% lower odds of rehospitalization (0.56; 95% CI, 0.53-0.59), and 16% lower odds of incident stroke (0.84; 95% CI, 0.72-0.99) compared with propensity-score matched controls. No significant associations were shown for incident heart failure (0.93; 95% CI, 0.84-1.04). The beneficial association of exercise-based CR on all-cause mortality was independent of sex, older age, comorbidities, and AF subtype. Conclusions Exercise-based CR among patients with incident AF was associated with lower odds of all-cause mortality, rehospitalization, and incident stroke at 18-month follow-up, supporting the provision of exercise-based CR for patients with AF.
对于患有心房颤动（AF）的患者，基于运动的心脏康复（CR）对临床终点的长期影响的证据有限。因此，我们将接受基于运动的 CR 的 AF 患者的 18 个月全因死亡率、住院率、卒中和心力衰竭与接受匹配对照的基于运动的 CR 的 AF 患者的电子病历进行了比较。
这项回顾性队列研究纳入了 2021 年 2 月 3 日从一个全球联邦健康研究网络获得的患者数据。接受基于运动的 CR 的 AF 患者按年龄、性别、种族、合并症、心血管程序和心血管药物与未接受基于运动的 CR 的 AF 患者进行倾向评分匹配。我们确定了 18 个月内全因死亡率、住院率、卒中和心力衰竭的发生率。在 1366422 例患有 AF 的患者中，有 11947 例在发生 AF 后 6 个月内有基于运动的 CR 的电子病历，他们与 11947 例无 CR 的 AF 患者进行了倾向评分匹配。与匹配对照组相比，基于运动的 CR 与全因死亡率降低 68%（优势比，0.32；95%置信区间，0.29-0.35）、再住院率降低 44%（0.56；95%置信区间，0.53-0.59）和卒中发生率降低 16%（0.84；95%置信区间，0.72-0.99）相关。对于心力衰竭的发生率，没有显示出显著的相关性（0.93；95%置信区间，0.84-1.04）。基于运动的 CR 对全因死亡率的有益关联独立于性别、年龄较大、合并症和 AF 亚型。
在患有 AF 的患者中，接受基于运动的 CR 与 18 个月时全因死亡率、再住院率和卒中发生率降低相关，支持为 AF 患者提供基于运动的 CR。
