单纯性先天性心脏病合并心力衰竭成年患者的心脏康复与不良事件
Cardiac rehabilitation and adverse events among adult patients with simple congenital heart disease and heart failure.
作者信息
Buckley Benjamin Jr, Kerstens Thijs P, France-Ratcliffe Madeleine, Lip Gregory Y H, Thijssen Dick Hj
机构信息
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom.
出版信息
Am J Prev Cardiol. 2024 Apr 29;18:100677. doi: 10.1016/j.ajpc.2024.100677. eCollection 2024 Jun.
AIMS
Improved care has resulted in prolonged survival of patients with congenital heart disease (ConHD), increasing age-related cardiovascular comorbidities. Although cardiovascular rehabilitation (CR) represents evidence-based care for heart failure (HF), the clinical impact of CR in patients with ConHD who developed HF during adulthood is unclear. We investigated 12-month mortality and morbidity in patients with simple ConHD diagnosed with HF with CR versus without CR.
METHODS
A retrospective cohort study was conducted for the time period February 2004 - February 2024. Utilizing TriNetX, a global federated health research network, a real-world dataset of simple ConHD patients was acquired to compare patients with vs. without (controls) prescription for exercise-based CR. Patients were propensity-score matched for age, sex, ethnicity, comorbidities, procedures, and medication. The primary outcome was a composite of all-cause mortality, ischemic stroke, and acute coronary syndrome (major adverse cardiovascular events; MACE) within 12 months.
RESULTS
Following propensity score matching, the total cohort consisted of 6,866 simple ConHD patients with HF. CR was associated with significantly lower odds for MACE (odds ratio (OR) 0.61 [95 % confidence interval (CI): 0.54-0.69]) and its individual components all-cause mortality (OR 0.40 [95 % CI 0.33-0.47]) and ischemic stroke (OR 0.75 [95 % CI 0.64-0.88]), but not acute coronary syndrome (OR 1.24 [95 % CI 0.91-1.69]).
CONCLUSION
CR was associated with significantly lower 12-month MACE in patients with simple ConHD with concomitant HF compared to usual care.
目的
改善治疗使先天性心脏病（ConHD）患者的生存期延长，与年龄相关的心血管合并症增加。尽管心脏康复（CR）是心力衰竭（HF）的循证治疗方法，但CR对成年期发生HF的ConHD患者的临床影响尚不清楚。我们调查了诊断为HF的单纯ConHD患者接受CR与未接受CR的12个月死亡率和发病率。
方法
对2004年2月至2024年2月期间进行了一项回顾性队列研究。利用全球联合健康研究网络TriNetX，获取单纯ConHD患者的真实世界数据集，以比较接受与未接受（对照）基于运动的CR处方的患者。对患者的年龄、性别、种族、合并症、手术和药物进行倾向评分匹配。主要结局是12个月内全因死亡率、缺血性卒中和急性冠状动脉综合征（主要不良心血管事件；MACE）的复合结局。
结果
倾向评分匹配后，总队列包括6866例患有HF的单纯ConHD患者。CR与MACE的显著较低几率相关（优势比（OR）0.61 [95%置信区间（CI）：0.54 - 0.69]）及其个体组成部分全因死亡率（OR 0.40 [95% CI 0.33 - 0.47]）和缺血性卒中（OR 0.75 [95% CI 0.64 - 0.88]），但与急性冠状动脉综合征无关（OR 1.24 [95% CI 0.91 - 1.69]）。
结论
与常规治疗相比，CR与单纯ConHD合并HF患者12个月MACE显著降低相关。
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