Liu Lisong, Chen Jun, Zhao Ning, Zhang Mingming, Zhou Lihui, Ren Xiaoxia, Zhang Ting, Zhao Pengcheng, Hu Dayi, Pang Xingxue, Jin Zhongyi
Cardiac Rehabilitation Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, China.
Doctoral Department, Capital Medical University, 100069 Beijing, China.
Rev Cardiovasc Med. 2022 Oct 21;23(11):356. doi: 10.31083/j.rcm2311356. eCollection 2022 Nov.
Cardiac rehabilitation is an important part of the therapeutic regimen for chronic heart failure. Acute decompensated heart failure (ADHF) in hospitalized patients were usually excluded from cardiac rehabilitation programs. The initiation of cardiac rehabilitation with ADHF usually occurs after hospital discharge. This study included recent clinical trials in patients beginning early exercise-based rehabilitation during their hospitalization and compared the efficacy and safety of early cardiac rehabilitation to ADHF patients who didn't receive cardiac rehabilitation.
Clinical trials were searched from the EMBASE, PubMed, CENTRAL, and WAN FANG. We included randomized controlled trials (RCTs) in which early exercise-based rehabilitation started during the index hospitalization, from the establishment of the database to July 2022. RevMan 5.4 was used for the statistical analysis.
Six studies, with a total of 668 patients were included; 336 patients in the early rehabilitation group and 332 patients in the control group. Exercise capacity was significantly improved in the 6-minute walk distance [mean difference (MD): 32.97, 95% CI: 31.03 to 34.90, 0.00001], and the Short Physical Performance Battery (MD: 1.40, 95% CI: 1.35 to 1.44, 0.00001). The rate of all-cause rehospitalization was significantly decreased in the early rehabilitation group (OR: 0.67, 95% CI: 0.45 to 0.99, = 0.04).
Early exercise-based rehabilitation for eligible ADHF in-patients starting during, or early after, hospitalization could significantly improve exercise capacity. A transitional, individualized, progressive, exercise-based rehabilitation program during hospitalization combined with post-discharge clinic rehabilitation is an integrated rehabilitation strategy for acute decompensated heart failure.
心脏康复是慢性心力衰竭治疗方案的重要组成部分。住院患者的急性失代偿性心力衰竭（ADHF）通常被排除在心脏康复项目之外。ADHF患者的心脏康复通常在出院后开始。本研究纳入了近期关于患者在住院期间开始早期运动康复的临床试验，并比较了早期心脏康复与未接受心脏康复的ADHF患者的疗效和安全性。
从EMBASE、PubMed、CENTRAL和万方数据库检索临床试验。纳入从数据库建立至2022年7月期间在首次住院期间开始早期运动康复的随机对照试验（RCT）。使用RevMan 5.4进行统计分析。
纳入6项研究，共668例患者；早期康复组336例患者，对照组332例患者。早期康复组的运动能力在6分钟步行距离方面显著改善[平均差（MD）：32.97，95%置信区间（CI）：31.03至34.90，P<0.00001]，以及简短体能状况量表（MD：1.40，95%CI：1.35至1.44，P<0.00001）。早期康复组的全因再住院率显著降低（比值比（OR）：0.67，95%CI：0.45至0.99，P = 0.04）。
对于符合条件的ADHF住院患者，在住院期间或住院后早期开始基于运动的康复可显著提高运动能力。住院期间过渡性、个体化、渐进性的基于运动的康复计划与出院后门诊康复相结合是急性失代偿性心力衰竭的综合康复策略。
