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老年心力衰竭住院患者的身体复健
Physical Rehabilitation for Older Patients Hospitalized for Heart Failure


Dalane W. Kitzman ... 心脑血管疾病 • 2021.07.15
NEJM 动画解读

心力衰竭患者的身体复健
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精细研究设计让REHAB-HF扭转老年心力衰竭患者康复研究颓势

 

和亚萍,魏盟*

上海嘉会国际医院心血管内科

*通讯作者

 

急性失代偿性心力衰竭(ADHF)住院的老年患者大多存在虚弱、生活质量差、频繁住院等情况,给社会带来巨大经济负担,而大多数针对ADHF进行的临床干预试验只取得了中性结果。研究者或许忽略了一些可能导致ADHF患者上述不良后果的重要因素。

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摘要


背景

在因急性失代偿性心力衰竭住院的老年患者中,身体虚弱、生活质量差、恢复延迟和频繁再住院的发生率高。针对该人群身体虚弱的干预措施尚未明确。

 

方法

我们开展了一项多中心、随机、对照试验,旨在评估涵盖身体功能4个方面(力量、平衡、灵活性和耐力)的过渡性、个体化、渐进式复健干预。干预在患者因心力衰竭住院期间或出院后早期开始,并且患者在出院后继续接受36次门诊治疗。主要结局是3个月时的简易体能状况量表(Short Physical Performance Battery)评分(总分范围为0~12,评分较低表示身体功能障碍较严重)。次要结局是6个月时,全因再住院率。

 

结果

共计349例患者接受了随机分组;175人被分配接受复健干预,174人被分配接受常规治疗(对照)。基线时,两组患者的身体功能均明显受损,97%的患者身体虚弱或处于虚弱前期(prefrail);两组中合并症的平均种数均为5种。干预组的患者保留率为82%,对干预的依从率为67%。针对基线简易体能状况量表评分和其他基线特征进行校正后,3个月时,干预组和对照组的简易体能状况量表评分的最小二乘均值(±SE)分别为8.3±0.2和6.9±0.2(组间平均差异,1.5;95%置信区间[CI],0.9~2.0;P<0.001)。6个月时,干预组和对照组的全因再住院率分别为1.18和1.28(率比,0.93;95% CI,0.66~1.19)。干预组有21例患者死亡(15例死于心血管原因),对照组有16例患者死亡(8例死于心血管原因)。两组的全因死亡率分别为0.13和0.10(率比,1.17;95% CI,0.61~2.27)。

 

结论

在老年急性失代偿性心力衰竭住院患者的多样化人群中,与常规治疗相比,涵盖身体功能多个方面的早期、过渡性、个体化、渐进式复健干预使患者身体功能有较大幅改善(由美国国立卫生研究院等资助,REHAB-HF在ClinicalTrials.org注册号为NCT02196038)。





作者信息

Dalane W. Kitzman, M.D., David J. Whellan, M.D., M.H.S., Pamela Duncan, P.T., Ph.D., Amy M. Pastva, P.T., Ph.D., Robert J. Mentz, M.D., Gordon R. Reeves, M.D., M.P.T., M. Benjamin Nelson, M.S., Haiying Chen, Ph.D., Bharathi Upadhya, M.D., Shelby D. Reed, Ph.D., Mark A. Espeland, Ph.D., LeighAnn Hewston, D.P.T., M.Ed., and Christopher M. O’Connor, M.D.
From the Department of Internal Medicine, Sections of Cardiovascular Medicine (D.W.K., M.B.N., B.U.) and Gerontology and Geriatric Medicine (D.W.K., M.A.E.), and the Departments of Neurology (P.D.) and Biostatistics and Data Science (H.C., M.A.E.), Wake Forest School of Medicine, Winston-Salem, the Department of Orthopedic Surgery, Doctor of Physical Therapy Division (A.M.P.), the Department of Medicine, Division of Cardiology (R.J.M.), and the Department of Population Health Sciences (S.D.R.), Duke University School of Medicine, Durham, and Novant Health Heart and Vascular Institute, Charlotte (G.R.R.) — all in North Carolina; the Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University (D.J.W.), and the Department of Physical Therapy, Jefferson College of Rehabilitation Sciences at Thomas Jefferson University (L.A.H.) — both in Philadelphia; and Inova Heart and Vascular Institute, Fairfax, VA (C.M.O.). Address reprint requests to Dr. Kitzman at the Department of Internal Medicine, Sections of Cardiovascular Medicine and Gerontology and Geriatric Medicine, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC 27157-1045, or at dkitzman@wakehealth.edu. A list of the investigators in this trial is provided in the Supplementary Appendix, available at NEJM.org.

 

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