Telecardiology Center, National Institute of Cardiology, Warszawa, Poland.
Duke University's School of Medicine, Durham, NC, United States.
Kardiol Pol. 2023;81(7-8):726-736. doi: 10.33963/KP.a2023.0116. Epub 2023 May 17.
Assessing prognosis in heart failure (HF) is of major importance.
The study aimed to define predictors influencing long-term cardiovascular mortality or HF hospitalization ("composite outcome") based on clinical status and measurements obtained after a 9-week hybrid comprehensive telerehabilitation (HCTR) program.
This analysis is based on the TELEREH-HF (TELEREHabilitation in Heart Failure) multicenter randomized trial that enrolled 850 HF patients (left ventricular ejection fraction [LVEF] ≤40%). Patients were randomized 1:1 to 9-week HCTR plus usual care (experimental arm) or usual care only (control arm) and followed for median (interquartile range [IQR]) 24 (20-24) months for development of the composite outcome.
Over 12-24 months of follow-up, 108 (28.1%) patients experienced the composite outcome. The predictors of our composite outcome were: nonischemic etiology of HF, diabetes, higher serum level of N-terminal prohormone of brain natriuretic peptide, creatinine, and high-sensitivity C-reactive protein; low carbon dioxide output at peak exercise; high minute ventilation and breathing frequency at maximum effort in cardiopulmonary exercise tests; increase in delta of average heart rate in 24-hour Holter ECG monitoring, lower LVEF, and patients' non-adherence to HCTR. The model discrimination C-index was 0.795 and decreased to 0.755 on validation conducted in the control sample which was not used in derivation. The 2-year risk of the composite outcome was 48% in the top tertile versus 5% in the bottom tertile of the developed risk score.
Risk factors collected at the end of the 9-week telerehabilitation period performed well in stratifying patients based on their 2-year risk of the composite outcome. Patients in the top tertile had an almost ten-fold higher risk compared to patients in the bottom tertile. Treatment adherence, but not peak VO2 or quality of life, was significantly associated with the outcome.
评估心力衰竭（HF）的预后非常重要。
本研究旨在基于临床状况和在 9 周混合远程综合康复（HCTR）计划后获得的测量值，确定影响长期心血管死亡率或 HF 住院治疗（“复合结局”）的预测因素。
该分析基于 TELEREH-HF（心力衰竭远程康复）多中心随机试验，该试验纳入了 850 例 HF 患者（左心室射血分数[LVEF]≤40%）。患者以 1:1 的比例随机分为 9 周 HCTR 加常规护理（实验组）或仅常规护理（对照组），并随访中位数（四分位距[IQR]）24（20-24）个月，以确定复合结局的发生情况。
在 12-24 个月的随访期间，108 例（28.1%）患者发生了复合结局。我们复合结局的预测因素包括：HF 的非缺血病因、糖尿病、脑钠肽前体 N 末端高敏血清水平、肌酐和高敏 C 反应蛋白升高；峰值运动时二氧化碳输出量低；心肺运动试验中最大努力时分钟通气量和呼吸频率高；24 小时动态心电图监测中平均心率的Δ增加、LVEF 降低以及患者对 HCTR 的不依从。模型判别 C 指数为 0.795，在未用于推导的对照组中进行验证时降至 0.755。在开发的风险评分中，最高三分位组的复合结局 2 年风险为 48%，最低三分位组为 5%。
在 9 周远程康复期结束时收集的危险因素在根据患者 2 年复合结局风险进行分层方面表现良好。与最低三分位组相比，最高三分位组的患者风险几乎增加了十倍。治疗依从性，但不是峰值 VO2 或生活质量，与结局显著相关。
