早期增加身体活动、心脏康复与植入式心脏复律除颤器植入后的生存。

Early Increased Physical Activity, Cardiac Rehabilitation, and Survival After Implantable Cardioverter-Defibrillator Implantation.

机构信息

Inova Heart and Vascular Institute, Fairfax, VA (B.D.A.).

Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (B.D.A.).

出版信息

Circ Cardiovasc Qual Outcomes. 2021 Aug;14(8):e007580. doi: 10.1161/CIRCOUTCOMES.120.007580. Epub 2021 Jul 21.

DOI:10.1161/CIRCOUTCOMES.120.007580

PMID:34284598

Abstract

BACKGROUND

Increased physical activity (PA) through cardiac rehabilitation (CR) improves outcomes in patients with heart failure and coronary disease, but CR referral remains infrequent. Implantable cardioverter-defibrillators (ICDs) can provide daily PA measurements to patients that may motivate them to increase PA, but it remains unclear if increased ICD measured PA is associated with improved outcomes with and without CR.

METHODS

This is a retrospective observational study of 41 731 Medicare beneficiaries with ICD implantation between January 1, 2014 and December 31, 2016. We linked daily ICD PA measurements and Medicare claims data to determine if increased PA is associated with a reduction in the likelihood of death or heart failure hospitalization. To determine if CR participation altered the effect of PA on outcomes, we performed two additional analyses matching CR participants and nonparticipants using propensity scores. The first match included demographics, comorbidities, and baseline PA measurements. The second match also included the change in PA measured during CR or the same time frame after ICD implant among nonparticipants.

RESULTS

The mean age was 75 (SD, 10) years, 30 182 beneficiaries (72.3%) were male, and 1324 (3%) participated in CR. Increased ICD detected PA was associated with improved survival. CR participants had a mean PA change of +9.7 (SD, 57.8) min/d, whereas nonparticipants had a mean change of -1.0 (SD, 59.7) min/d (<0.001). After matching for demographics, comorbidities and baseline PA, CR participants had significantly lower 1- to 3-year mortality (hazard ratio, 0.76 [95% CI, 0.69-0.85], =0.03). After additionally matching for the ICD measured change in PA during CR there were no differences in mortality with and without CR (hazard ratio, 1.00 [95% CI, 0.82-1.21], =0.87). Every 10 minutes of increased daily PA was associated with a 1.1% reduction in all-cause mortality in both groups.

CONCLUSIONS

Among Medicare beneficiaries with ICDs, small increases in PA were associated with significant reductions in all-cause mortality.

摘要

背景

通过心脏康复（CR）增加身体活动（PA）可改善心力衰竭和冠心病患者的预后，但 CR 的转诊仍然不频繁。植入式心脏复律除颤器（ICD）可以为患者提供日常 PA 测量值，这可能会激励他们增加 PA，但尚不清楚增加的 ICD 测量 PA 是否与 CR 有无相关联与改善预后。

方法

这是一项回顾性观察研究，纳入了 2014 年 1 月 1 日至 2016 年 12 月 31 日期间接受 ICD 植入的 41731 名 Medicare 受益人的数据。我们将每日 ICD PA 测量值和 Medicare 理赔数据进行了关联，以确定 PA 是否增加与降低死亡率或心力衰竭住院率的可能性相关。为了确定 CR 参与是否改变了 PA 对结果的影响，我们使用倾向评分对 CR 参与者和非参与者进行了另外两项分析。第一次匹配包括人口统计学、合并症和基线 PA 测量值。第二次匹配还包括非参与者在 CR 或 ICD 植入后同一时间段内的 PA 变化。

结果

平均年龄为 75（SD，10）岁，30182 名（72.3%）受益人为男性，1324 名（3%）参与了 CR。ICD 检测到的 PA 增加与生存改善相关。CR 参与者的 PA 平均变化为+9.7（SD，57.8）min/d，而非参与者的平均变化为-1.0（SD，59.7）min/d（<0.001）。在匹配人口统计学、合并症和基线 PA 后，CR 参与者在 1 至 3 年内的死亡率显著降低（风险比，0.76 [95%CI，0.69-0.85]，=0.03）。在另外匹配 CR 期间 ICD 测量的 PA 变化后，CR 有和没有 CR 的死亡率没有差异（风险比，1.00 [95%CI，0.82-1.21]，=0.87）。在两组中，PA 每天增加 10 分钟与全因死亡率降低 1.1%相关。