Mills Mark, Johnson Elizabeth, Zafar Hamza, Horwood Andrew, Lax Nicola, Charlesworth Sarah, Gregory Anna, Lee Justin, Sahu Jonathan, Kirkwood Graeme, Kelland Nicholas, Kyriacou Andreas
Core Medical Trainee Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU.
Cardiac Rehabilitation Nurse Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU.
Br J Cardiol. 2020 Jun 11;27(2):20. doi: 10.5837/bjc.2020.020. eCollection 2020.
There is increasing evidence for the role of exercise-based cardiac rehabilitation in the management of patients with atrial fibrillation (AF). However, this intervention has not yet been widely adopted within the National Health Service (NHS). We performed a feasibility study on the utilisation of an established NHS cardiac rehabilitation programme in the management of AF, and examined the effects of this intervention on exercise capacity, weight, and psychological health. We then identified factors that might prevent patients from enrolling on our programme. Patients with symptomatic AF were invited to participate in an established six-week exercise-based cardiac rehabilitation programme, composed of physical activity and education sessions. At the start of the programme, patients were weighed and measured, performed the six-minute walk test (6MWT), completed the Generalised Anxiety Disorder Questionnaire (GAD-7), and the Patient Health Questionnaire (PHQ-9). Measurements were repeated on completion of the programme. Over two years, 77 patients were invited to join the programme. Twenty-two patients (28.5%) declined participation prior to initial assessment and 22 (28.5%) accepted and attended the initial assessment, but subsequently withdrew from the programme. In total, 33 patients completed the entire programme (63.9 ± 1.7 years, 58% female). On completion, patients covered longer distances during the 6MWT, had lower GAD-7 scores, and lower PHQ-9 scores, compared with their baseline results. Compared with patients that completed the entire programme, those who withdrew from the study had, at baseline, a significantly higher body mass index (BMI), covered a shorter distance during the 6MWT, and had higher PHQ-9 and GAD-7 scores. In conclusion, enrolling patients with AF into an NHS cardiac rehabilitation programme is feasible, with nearly half of those invited completing the programme. In this feasibility study, cardiac rehabilitation resulted in an improved 6MWT, and reduced anxiety and depression levels, in the short term. Severe obesity, higher anxiety and depression levels, and lower initial exercise capacity appear to be barriers to completing exercise-based cardiac rehabilitation. These results warrant further investigation in larger cohorts.
越来越多的证据表明，基于运动的心脏康复在心房颤动（AF）患者的管理中发挥着作用。然而，这种干预措施尚未在国民医疗服务体系（NHS）中得到广泛应用。我们对一项既定的NHS心脏康复计划用于AF管理进行了可行性研究，并考察了该干预措施对运动能力、体重和心理健康的影响。然后，我们确定了可能阻碍患者参加我们计划的因素。有症状的AF患者被邀请参加一项既定的为期六周的基于运动的心脏康复计划，该计划包括体育活动和教育课程。在计划开始时，对患者进行称重和测量，进行六分钟步行测试（6MWT），完成广泛性焦虑障碍问卷（GAD - 7）和患者健康问卷（PHQ - 9）。在计划结束时重复进行测量。在两年多的时间里，77名患者被邀请参加该计划。22名患者（28.5%）在初次评估前拒绝参与，22名患者（28.5%）接受并参加了初次评估，但随后退出了该计划。总共有33名患者完成了整个计划（年龄63.9±1.7岁，58%为女性）。完成计划后，与基线结果相比，患者在6MWT中行走的距离更长，GAD - 7得分更低，PHQ - 9得分更低。与完成整个计划的患者相比，退出研究的患者在基线时的体重指数（BMI）显著更高，在6MWT中行走的距离更短，PHQ - 9和GAD - 7得分更高。总之，将AF患者纳入NHS心脏康复计划是可行的，近一半被邀请的患者完成了该计划。在这项可行性研究中，心脏康复在短期内改善了6MWT，并降低了焦虑和抑郁水平。严重肥胖、更高的焦虑和抑郁水平以及较低的初始运动能力似乎是完成基于运动的心脏康复的障碍。这些结果值得在更大的队列中进一步研究。
