Chen Shyh-Ming, Wu Ming-Kung, Chen Ching, Wang Lin-Yi, Guo Nai-Wen, Wei Chin-Ling, Zheng You-Cheng, Hsiao Hao-Yi, Wu Po-Jui, Chen Yung-Lung, Chen Chien-Jen, Hang Chi-Ling
Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China.
Chang Gung University College of Medicine, Taiwan, Republic of China.
Heliyon. 2024 Apr 30;10(9):e30493. doi: 10.1016/j.heliyon.2024.e30493. eCollection 2024 May 15.
This study aimed to evaluate the prevalence of cognitive impairment among patients with acute heart failure (AHF), its prognosis, and the effects of cardiac rehabilitation (CR) on these patients' outcomes.
Overall, 247 consecutive AHF patients (median age, 60 years; males, 78.5 %) were evaluated from March 2015 to May 2021. Patients received an AHF disease management program coordinated by an HF specialist nurse and underwent a Luria-Nebraska Neuropsychological battery-screening test (LNNB-S) assessment during admission. Cognitive impairment was defined as an LNNB-S score ≥10. Patients who underwent at least one session of phase II CR and continued with the home-based exercise program were considered to have received CR. The primary endpoint was composite all-cause mortality or readmission after a 3.30-year follow-up (interquartile range, 1.69-5.09 years).
Cognitive impairment occurred in 53.0 % and was associated with significantly higher composite endpoint, all-cause mortality, and readmission rates (p=<0.001, 0.001, and 0.015, respectively). In the total cohort, 40.9 % of patients experienced the composite endpoint. Multivariate analysis showed that the peak VO was a significant predictor of the composite endpoint. After adjustment, CR significantly decreased the event rate of the composite endpoint and the all-cause mortality in patients with cognitive impairment (log-rank p = 0.024 and 0.009, respectively). However, CR did not have a significant benefit on the composite endpoint and the all-cause mortality in patients without cognitive impairment (log-rank p = 0.682 and 0.701, respectively).
Cognitive impairment is common in AHF patients and can lead to poor outcomes. CR is a standard treatment to improve prognosis.
本研究旨在评估急性心力衰竭（AHF）患者认知障碍的患病率、预后以及心脏康复（CR）对这些患者预后的影响。
2015年3月至2021年5月期间，对247例连续的AHF患者（中位年龄60岁；男性占78.5%）进行了评估。患者接受了由心力衰竭专科护士协调的AHF疾病管理计划，并在入院期间接受了卢里亚-内布拉斯加神经心理成套筛查测试（LNNB-S）评估。认知障碍定义为LNNB-S评分≥10分。接受至少一次II期CR治疗并继续进行家庭锻炼计划的患者被视为接受了CR治疗。主要终点是3.30年随访（四分位间距为1.69 - 5.09年）后的全因死亡或再入院的复合终点。
认知障碍发生率为53.0%，且与显著更高的复合终点、全因死亡率和再入院率相关（分别为p<0.001、0.001和0.015）。在整个队列中，40.9%的患者出现了复合终点。多变量分析显示，峰值VO是复合终点的显著预测因素。调整后，CR显著降低了认知障碍患者复合终点事件率和全因死亡率（对数秩检验p分别为0.024和0.009）。然而，CR对无认知障碍患者的复合终点和全因死亡率没有显著益处（对数秩检验p分别为0.682和0.701）。
认知障碍在AHF患者中很常见，可导致不良预后。CR是改善预后的标准治疗方法。
