Author Affiliations: Department of Nursing (Ms Yu), Institute of Clinical Nursing (Dr Y-C Chen), College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; and Cardiovascular Division, Department of Internal Medicine (Dr Chun-Yen Chen), Mackay Medical College, Department of Medicine (Drs Chun-Yen Chen and Hu), Department of Rehabilitation Medicine (Drs Cheng, Chi-Yen Chen, and Hu), Mackay Memorial Hospital, Taipei, Taiwan.
J Cardiopulm Rehabil Prev. 2024 Sep 1;44(5):311-316. doi: 10.1097/HCR.0000000000000901. Epub 2024 Sep 3.
Following acute myocardial infarction (AMI), patients with diabetes mellitus (DM) have a poorer prognosis than those without DM. This study aimed to investigate the benefit of cardiac rehabilitation on cardiorespiratory fitness in patients with AMI, examining whether this effect varied depending on DM and glycated hemoglobin (HbA1c) levels.
Data were collected from the medical records of 324 patients diagnosed with AMI who were subsequently referred to participate in a supervised exercise-based cardiac rehabilitation program. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing before and at 3 and 6 mo after the start of cardiac rehabilitation. Linear mixed models were used to evaluate changes in cardiorespiratory fitness between patients with and without DM during the follow-up period.
In total, 106 patients (33%) had DM. Both patients with and without DM showed a significant improvement in cardiorespiratory fitness from baseline to the 6-mo follow-up. However, the improvement was significantly lower in patients with DM than in those without DM (1.9 ± 1.5 vs. 3.7 ± 3.2 mL/kg/min, P < .001). Among patients with DM, those with HbA1c levels < 7% showed a greater improvement in cardiorespiratory fitness than those with HbA1c ≥ 7% (2.7 ± 1.5 vs. 1.1 ± 1.8 mL/kg/min, P < .001) during the follow-up period.
Improvements in cardiorespiratory fitness following cardiac rehabilitation were significantly lower in patients with AMI and DM. The response to cardiac rehabilitation in patients is influenced by HbA1c levels. These findings suggest potential implications for individualizing cardiac rehabilitation programming and ensuring optimal glycemic control in patients with AMI and DM.
急性心肌梗死（AMI）后，糖尿病（DM）患者的预后较无 DM 患者差。本研究旨在探讨心脏康复对 AMI 患者心肺功能的益处，观察其对 DM 和糖化血红蛋白（HbA1c）水平的影响。
收集 324 例 AMI 患者的病历资料，这些患者随后被转介参加基于监督运动的心脏康复计划。在心脏康复开始前、3 个月和 6 个月时，使用心肺运动测试评估心肺功能。采用线性混合模型评估随访期间 DM 患者和非 DM 患者心肺功能的变化。
共 106 例（33%）患者患有 DM。DM 患者和非 DM 患者的心肺功能均从基线到 6 个月随访均有显著改善。然而，DM 患者的改善明显低于非 DM 患者（1.9±1.5 比 3.7±3.2 mL/kg/min，P<.001）。在 DM 患者中，HbA1c 水平<7%的患者心肺功能改善程度大于 HbA1c≥7%的患者（2.7±1.5 比 1.1±1.8 mL/kg/min，P<.001）。
AMI 和 DM 患者心脏康复后心肺功能的改善明显较低。心脏康复对患者的反应受 HbA1c 水平的影响。这些发现提示个体化心脏康复方案和确保 AMI 和 DM 患者血糖控制优化的潜在意义。
