≥90 岁急性心力衰竭患者早期急性期康复启动对结局的影响。
Association of early acute-phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure.
机构信息
The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.
出版信息
J Am Geriatr Soc. 2023 Jun;71(6):1840-1850. doi: 10.1111/jgs.18283. Epub 2023 Mar 1.
BACKGROUND
Data on the potential benefit of acute-phase rehabilitation initiation in very old (aged ≥90) patients with acute heart failure (AHF) have been scarce.
METHODS
We retrospectively analyzed data from the Diagnosis Procedure Combination database, which is a nationwide inpatient database. This study included patients hospitalized for heart failure (HF) from January 2010 to March 2018, those aged ≥90 years, who had a length of stay of ≥3 days, New York Heart Association (NYHA) class of ≥II, and had not undergone major procedures under general anesthesia. Propensity score matching and generalized linear models were used to compare in-hospital mortality, length of stay, 30-day readmission rate due to HF, all-cause 30-day readmission, and improvement in activities of daily living (ADL) between patients with and without an acute-phase rehabilitation initiation, which is defined as the rehabilitation initiation within 2 days after hospital admission.
RESULTS
Acute-phase rehabilitation was initiated in 8588 of 41,896 eligible patients. Propensity score matching created 8587 pairs. Patients with acute-phase rehabilitation initiation have lower in-hospital mortality (9.0% vs. 11.2%, p < 0.001). Acute-phase rehabilitation initiation was associated with lower in-hospital mortality (odds ratio, 0.778; 95% confidence interval, 0.704-0.860). Patients with acute-phase rehabilitation initiation have a shorter median length of stay (17 days vs. 18 days, p < 0.001), lower 30-day readmission rate due to HF (5.5% vs. 6.4%, p = 0.011) and all-cause 30-day readmission (10.2% vs. 11.2%, p = 0.036), and better ADL improvement (49.7% vs. 46.9%, p < 0.001). Subgroup analysis revealed consistent results (sex, body mass index, NYHA class, and Barthel Index).
CONCLUSIONS
The acute-phase rehabilitation initiation was associated with improved short-term clinical outcomes in patients aged ≥90 years with AHF.
背景
关于急性发病期康复治疗对非常高龄（≥90 岁）急性心力衰竭（AHF）患者潜在益处的数据较为匮乏。
方法
我们回顾性分析了来自 Diagnosis Procedure Combination 数据库的数据，该数据库是一个全国性的住院患者数据库。本研究纳入了 2010 年 1 月至 2018 年 3 月因心力衰竭（HF）住院的患者，年龄≥90 岁，住院时间≥3 天，纽约心脏协会（NYHA）心功能分级≥Ⅱ级，且未接受全麻下的主要手术。采用倾向评分匹配和广义线性模型比较了有和无急性发病期康复治疗的患者的院内死亡率、住院时间、HF 30 天再入院率、全因 30 天再入院率和日常生活活动（ADL）改善情况，急性发病期康复治疗定义为入院后 2 天内开始康复治疗。
结果
在 41896 例符合条件的患者中，8588 例接受了急性发病期康复治疗。采用倾向评分匹配创建了 8587 对。接受急性发病期康复治疗的患者院内死亡率较低（9.0% vs. 11.2%，p<0.001）。急性发病期康复治疗与较低的院内死亡率相关（比值比，0.778；95%置信区间，0.704-0.860）。接受急性发病期康复治疗的患者中位住院时间更短（17 天 vs. 18 天，p<0.001），HF 30 天再入院率更低（5.5% vs. 6.4%，p=0.011），全因 30 天再入院率更低（10.2% vs. 11.2%，p=0.036），ADL 改善更好（49.7% vs. 46.9%，p<0.001）。亚组分析结果一致。
结论
急性发病期康复治疗与≥90 岁 AHF 患者的短期临床结局改善相关。
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