Association of Home-Based Cardiac Rehabilitation With Lower Mortality in Patients With Cardiovascular Disease: Results From the Veterans Health Administration Healthy Heart Program.
Association of Home-Based Cardiac Rehabilitation With Lower Mortality in Patients With Cardiovascular Disease: Results From the Veterans Health Administration Healthy Heart Program.
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DOI：
10.1161/jaha.122.025856
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发表时间：
2023-03-07
影响因子：
5.4
通讯作者：
Whooley, Mary A.
中科院分区：
文献类型：
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作者：
Krishnamurthi, Nirupama;Schopfer, David W.;Shen, Hui;Rohrbach, Gregory;Elnaggar, Abdelaziz;Whooley, Mary A.
在临床试验和荟萃分析中，家庭心脏康复 (HBCR) 和传统设施心脏康复 (CR) 项目对死亡率的影响相似。然而，HBCR 对临床实践中死亡率的影响尚不清楚。因此，我们试图比较 HBCR 参与者与非参与者的死亡率。我们评估了 2013 年至 2018 年间在旧金山退伍军人健康管理局转诊并有资格接受门诊 CR 的所有患者。选择参加机构 CR 的患者和住院 30 天内死亡的患者被排除在外。选择参加 HBCR 的患者在 12 周内接受了多达 9 次电话辅导和励志访谈课程。所有患者均随访至 2021 年 6 月 30 日。我们使用具有逆概率治疗权重的 Cox 比例风险回归模型来比较 HBCR 参与者与非参与者的死亡率。在 1120 名被转诊并符合资格的患者（平均年龄 68 岁，98% 男性，76% 白人）中，490 名 (44%) 参加了 HBCR。在中位随访 4.2 年期间，185 名患者 (17%) 死亡。 490 名 HBCR 参与者与 630 名非参与者相比，死亡率较低（12% 比 20%；P<0.01）。在根据患者人口统计数据和合并症进行调整的逆概率加权 Cox 回归分析中，HBCR 参与者与非参与者相比，死亡风险仍然低 36%（风险比，0.64 [95% CI，0.45–0.90]，P=0.01）。在符合 CR 资格的患者中，参与 HBCR 可使死亡率风险降低 36%。尽管在观察性研究中永远无法消除无法测量的混杂因素，但我们的研究结果表明 HBCR 可能会使无法参加传统 CR 项目的患者受益。
Home‐based cardiac rehabilitation (HBCR) and traditional facility‐based cardiac rehabilitation (CR) programs have similar effects on mortality in clinical trials and meta‐analyses. However, the effect of HBCR on mortality in clinical practice settings is less clear. Therefore, we sought to compare mortality rates in HBCR participants versus nonparticipants. We evaluated all patients who were referred to and eligible for outpatient CR between 2013 and 2018 at the San Francisco Veterans Health Administration. Patients who chose to attend facility‐based CR and those who died within 30 days of hospitalization were excluded. Patients who chose to participate in HBCR received up to 9 telephonic coaching and motivational interviewing sessions over 12 weeks. All patients were followed through June 30, 2021. We used Cox proportional hazards regression models with inverse probability treatment weighting to compare mortality in HBCR participants versus nonparticipants. Of the 1120 patients (mean age 68, 98% male, 76% White) who were referred and eligible, 490 (44%) participated in HBCR. During a median follow‐up of 4.2 years, 185 patients (17%) died. Mortality was lower among the 490 HBCR participants versus the 630 nonparticipants (12% versus 20%; P<0.01). In an inverse probability weighted Cox regression analysis adjusted for patient demographics and comorbid conditions, the hazard of mortality remained 36% lower among HBCR participants versus nonparticipants (hazard ratio, 0.64 [95% CI, 0.45–0.90], P=0.01). Among patients eligible for CR, participation in HBCR was associated with 36% lower hazard of mortality. Although unmeasured confounding can never be eliminated in an observational study, our findings suggest that HBCR may benefit patients who cannot attend traditional CR programs.