Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Rehabilitation, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
ESC Heart Fail. 2024 Oct;11(5):3033-3040. doi: 10.1002/ehf2.14875. Epub 2024 Jun 6.
This study aimed to investigate the association between the time to achieve walkability after cardiac surgery and the risk of cardiovascular disease after hospital discharge.
We conducted a prospective cohort study involving 553 ambulatory patients aged 71.5 (range, 64.0-77.0) years who underwent cardiac surgery. All patients were divided into five groups based on the time to achieve walkability ≥100 m within 1, 2, 3, 4 or 5 days after cardiac surgery. We examined the risk of post-cardiovascular disease outcomes, including readmission due to heart failure, ischaemic heart disease and other cardiovascular disease, according to the time to achieve walkability with reference to 5 days using the Fine and Gray regression model, considering competing risks.
In the survival curve analysis, we examined the time to experience post-cardiovascular disease incidence after hospital discharge. During a median of 3.3 years of follow-up, 118 patients developed cardiovascular disease. We observed a positive association between the time to achieve walkability and cardiovascular disease risk, particularly heart failure. The multivariate hazard ratios (95% confidence intervals) for heart failure readmission were N/A (not assessed due to the sample size being too small) for 1 day, 0.31 (0.10-0.99) for 2 days, 0.60 (0.21-1.79) for 3 days and 0.76 (0.22-2.72) for 4 days (P for trend = 0.032).
The shorter walkability achievement time was associated with a lower risk of cardiovascular diseases, more specifically heart failure readmission, among patients who underwent cardiac surgery. The time required to achieve walkability is a useful predictor for cardiovascular diseases after hospital discharge.
本研究旨在探讨心脏手术后达到可步行状态的时间与出院后心血管疾病风险之间的关系。
我们进行了一项前瞻性队列研究，纳入了 553 名年龄为 71.5 岁（范围为 64.0-77.0 岁）的门诊患者，他们接受了心脏手术。所有患者根据心脏手术后达到可步行 100m 以上的时间分为 5 组，分别为 1、2、3、4 或 5 天。我们使用 Fine 和 Gray 回归模型，考虑竞争风险，根据达到可步行状态的时间（以 5 天为参照）来检查心血管疾病结果（包括因心力衰竭、缺血性心脏病和其他心血管疾病再入院）的风险。
在生存曲线分析中，我们检查了出院后发生心血管疾病的时间。在中位 3.3 年的随访期间，118 名患者发生了心血管疾病。我们发现达到可步行状态的时间与心血管疾病风险呈正相关，特别是心力衰竭。心力衰竭再入院的多变量风险比（95%置信区间）为 1 天为 N/A（由于样本量太小而无法评估），2 天为 0.31（0.10-0.99），3 天为 0.60（0.21-1.79），4 天为 0.76（0.22-2.72）（趋势 P=0.032）。
心脏手术后达到可步行状态的时间越短，患者发生心血管疾病的风险越低，特别是心力衰竭再入院的风险越低。达到可步行状态所需的时间是预测出院后心血管疾病的有用指标。
