Ueno Kensuke, Kaneko Hidehiro, Kamiya Kentaro, Okada Akira, Konishi Masaaki, Imamura Teruhiko, Suzuki Yuta, Fujiu Katsuhito, Takeda Norifumi, Morita Hiroyuki, Ako Junya, Node Koichi, Yasunaga Hideo, Takeda Norihiko, Komuro Issei
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.
Crit Care Med. 2025 Jan 1;53(1):e87-e95. doi: 10.1097/CCM.0000000000006462. Epub 2024 Oct 30.
The benefits of early rehabilitation for patients with acute heart failure (HF) requiring IV inotropic drugs have yet to be determined. We investigated the association between early rehabilitation and short-term clinical outcomes in patients with acute HF requiring IV inotropic drugs.
Retrospective cohort study.
This study used data including more than 90% of patients at a tertiary emergency hospital in Japan.
This study included patients with acute HF who required IV inotropic drugs within 2 days of admission.
We compared patients who commenced rehabilitation within 2 days of admission (the early rehabilitation group) and those who did not (the control group).
Propensity score matching was used to compare in-hospital mortality, 30-day all-cause and HF readmissions, length of stay, and Barthel Index (BI) at discharge between patients who received early rehabilitation and those who did not. Totally, 38,302 patients were eligible for inclusion; of these, 5,127 received early rehabilitation and 5,126 pairs were generated by propensity score matching. After propensity score matching, the patients who received early rehabilitation had a lower in-hospital mortality rate than those who did not (9.9% vs. 13.2%; p < 0.001). The relative risk (95% CI) of early rehabilitation for in-hospital mortality was 0.75 (0.67-0.83). Patients undergoing early rehabilitation exhibited a shorter mean length of stay (25.5 vs. 27.1; p < 0.001), lower 30-day all-cause (14.1% vs. 16.4%; p = 0.001) and HF (8.6% vs. 10.4%; p = 0.002) readmissions, and higher BI scores at discharge (68 vs. 67; p = 0.096). Consistent findings were observed across subgroups, including in patients 80 years old or older, those with a body mass index less than 18.5 kg/m 2 , and those with BI scores less than 60.
The early prescription of rehabilitation was associated with favorable short-term outcomes even for patients with acute HF requiring IV inotropic drugs.
急性心力衰竭（HF）患者使用静脉注射正性肌力药物时早期康复的益处尚未确定。我们调查了急性HF患者使用静脉注射正性肌力药物时早期康复与短期临床结局之间的关联。
回顾性队列研究。
本研究使用了日本一家三级急诊医院超过90%患者的数据。
本研究纳入了入院2天内需要静脉注射正性肌力药物的急性HF患者。
我们比较了入院2天内开始康复治疗的患者（早期康复组）和未开始康复治疗的患者（对照组）。
采用倾向得分匹配法比较早期康复治疗患者和未进行早期康复治疗患者的院内死亡率、30天全因再入院率和HF再入院率、住院时间以及出院时的Barthel指数（BI）。总共38302例患者符合纳入标准；其中，5127例接受了早期康复治疗，并通过倾向得分匹配法生成了5126对配对患者。倾向得分匹配后，接受早期康复治疗的患者院内死亡率低于未接受早期康复治疗的患者（9.9%对13.2%；p<0.001）。早期康复治疗院内死亡的相对风险（95%CI）为0.75（0.67-0.83）。接受早期康复治疗的患者平均住院时间较短（25.5天对27.1天；p<0.001），30天全因再入院率（14.1%对16.4%；p=0.001）和HF再入院率（8.6%对10.4%；p=0.002）较低，出院时BI评分较高（68分对67分；p=0.096）。在各亚组中均观察到一致的结果，包括80岁及以上患者、体重指数低于18.5kg/m²的患者以及BI评分低于60分的患者。
即使对于需要静脉注射正性肌力药物的急性HF患者，早期康复治疗的处方也与良好的短期结局相关。
