心脏康复与心力衰竭患者全因死亡率：一项回顾性队列研究。

Cardiac rehabilitation and all-cause mortality in patients with heart failure: a retrospective cohort study.

机构信息

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK.

TriNetX LLC, Cambridge, MA, USA.

出版信息

Eur J Prev Cardiol. 2021 Dec 29;28(15):1704-1710. doi: 10.1093/eurjpc/zwab035.

DOI:10.1093/eurjpc/zwab035

PMID:34333607

Abstract

AIMS

Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF). The aim of this study was therefore to investigate the association of exercise-based CR with all-cause mortality, hospitalisation, stroke, and atrial fibrillation in patients with heart failure.

METHODS AND RESULTS

A retrospective cohort study was conducted which utilized a global federated health research network, primarily in the USA. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of CR and/or exercise programmes within 6 months of an HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, comorbidities, medications, and procedures (controls). We ascertained 2-year incidence of all-cause mortality, hospitalization, stroke, and atrial fibrillation. Following propensity score matching, a total of 40 364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality [odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62], 26% lower odds of hospitalization (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to controls, after propensity score matching. The beneficial association of CR and exercise on all-cause mortality was consistent across all subgroups, including patients with HFrEF (0.52, 95% CI 0.48-0.56) and HFpEF (0.65, 95% CI 0.60-0.71).

CONCLUSION

Exercise-based CR was associated with lower odds of all-cause mortality, hospitalizations, incident stroke, and incident atrial fibrillation at 2-year follow-up for patients with HF (including patients with HFrEF and HFpEF).

摘要

目的

尽管运动训练在心血管疾病的二级预防中具有益处，但运动为基础的心脏康复（CR）对心力衰竭（HF）患者死亡率的影响存在相互矛盾的结果。因此，本研究旨在调查基于运动的 CR 与心力衰竭患者全因死亡率、住院、卒中和心房颤动的相关性。

方法和结果

进行了一项回顾性队列研究，该研究利用了一个全球性的联邦健康研究网络，主要在美国。将 HF 患者分为有电子病历记录的 CR 和/或 HF 诊断后 6 个月内的运动计划的患者，以及无电子病历记录的患者。对接受基于运动的 CR 的 HF 患者，通过年龄、性别、种族、合并症、药物和程序（对照组）进行倾向评分匹配，以匹配无基于运动的 CR 的 HF 患者。我们确定了全因死亡率、住院、卒中和心房颤动的 2 年发生率。在进行倾向评分匹配后，共确定了 40364 名 HF 患者。与对照组相比，基于运动的 CR 使全因死亡率的可能性降低了 42%[比值比 0.58，95%置信区间（CI）：0.54-0.62]，住院可能性降低了 26%[0.74，95% CI 0.71-0.77]，新发卒中的可能性降低了 37%[0.63，95% CI 0.51-0.79]，新发心房颤动的可能性降低了 53%[0.47，95% CI 0.4-0.55]。在倾向评分匹配后，CR 和运动对全因死亡率的有益关联在所有亚组中均一致，包括射血分数保留的心衰（HFpEF）（0.52，95% CI 0.48-0.56）和射血分数降低的心衰（HFrEF）（0.65，95% CI 0.60-0.71）患者。