Cardiac Rehabilitation Reduces 2-Year Mortality After Coronary Artery Bypass Grafting.
Cardiac Rehabilitation Reduces 2-Year Mortality After Coronary Artery Bypass Grafting.
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心脏康复可降低冠状动脉搭桥术后 2 年死亡率。
DOI：
10.1016/j.athoracsur.2023.05.044
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Thompson,MichaelP
中科院分区：
文献类型：
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作者：
Bauer,TylerM;Yaser,JessicaM;Daramola,Temilolaoluwa;Mansour,AlexandraI;Ailawadi,Gorav;Pagani,FrancisD;Theurer,Patricia;Likosky,DonaldS;Keteyian,StevenJ;Thompson,MichaelP
心脏康复(CR)是为接受冠状动脉血运重建手术的患者提供的一种有监督的门诊锻炼和降低风险的计划。多个专业社会指南支持冠状动脉旁路移植术(CABG)后CR的使用，这是基于对具有替代结果的经皮冠状动脉介入治疗和CABG人群的研究。这项全州范围内对接受CABG的患者的分析评估了CR使用与长期死亡率之间的关系。方法将联邦医疗保险服务费用索赔与2015年1月1日至2019年9月30日期间孤立CABG后活着出院的患者的手术数据联系起来。门诊设施声明用于确定出院后1年内的任何CR使用情况。出院后2年内死亡是主要结果。混合效应Logistic回归被用来预测CR的使用，并对各种并发症进行了调整。结果6412例患者中有3848例(60.0%)平均23.2(SD，12.0)疗程进入CR，其中770例(12.0%)完成了所有推荐的36疗程。Logistic回归表明，年龄增加、出院回家(与扩展护理机构相比)和住院时间较短是出院后CR使用的预测因素(P<；0.05)。未经调整和IPTW分析显示，CR使用者与非CR使用者相比，2年死亡率显著降低(未调整：减少9.4%；95%CI，10.8%-7.9%；P<；.001；IPTW：−减少4.8%；95%CI，6.0%-3.5%；P<；.001)。未来的质量倡议应考虑确定和解决CR注册和完成情况不佳的根本原因。
BackgroundCardiac rehabilitation (CR) is a supervised outpatient exercise and risk reduction program offered to patients who have undergone coronary revascularization procedures. Multiple professional societal guidelines support the use of CR after coronary artery bypass grafting (CABG) based on studies in combined percutaneous coronary intervention and CABG populations with surrogate outcomes. This statewide analysis of patients undergoing CABG evaluated the relationship between CR use and long-term mortality.MethodsMedicare fee-for-service claims were linked to surgical data for patients discharged alive after isolated CABG from January 1, 2015, through September 30, 2019. Outpatient facility claims were used to identify any CR use within 1 year of discharge. Death within 2 years of discharge was the primary outcome. Mixed-effects logistic regression was used to predict CR use, adjusting for a variety of comorbidities. Unadjusted and inverse probability treatment weighting (IPTW) were used to compare 2-year mortality among CR users vs nonusers.ResultsA total of 3848 of 6412 patients (60.0%) were enrolled in CR for an average of 23.2 (SD, 12.0) sessions, with 770 of 6412 (12.0%) completing all recommended 36 sessions. Logistic regression identified increasing age, discharge to home (vs extended care facility), and shorter length of stay as predictors of postdischarge CR use (P< .05). Unadjusted and IPTW analyses showed significant reduction in 2-year mortality in CR users compared with CR nonusers (unadjusted: 9.4% reduction; 95% CI, 10.8%-7.9%;P< .001; IPTW: −4.8% reduction; 95% CI, 6.0%-3.5%;P< .001).ConclusionsThese data suggest that CR use is associated with lower 2-year mortality. Future quality initiatives should consider identifying and addressing root causes of poor CR enrollment and completion.