Exercise training workloads in cardiac rehabilitation are associated with clinical outcomes in patients with heart failure
Exercise training workloads in cardiac rehabilitation are associated with clinical outcomes in patients with heart failure
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DOI：
10.1016/j.ahj.2018.05.017
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发表时间：
2018-10-01
影响因子：
4.8
通讯作者：
Brawner, Clinton A.
中科院分区：
文献类型：
--
作者：
Keteyian, Steven J.;Kerrigan, Dennis J.;Brawner, Clinton A.
背景在冠心病患者中，运动负荷（即，任务代谢当量（METs）与预后独立相关，其中患者在进入和完成心脏康复（CR）后进行运动训练。未知的是CR运动训练负荷和心力衰竭（HF）患者的临床结局之间的关联。方法在本回顾性分析中使用了参加早期门诊CR计划的HF患者。进入和完成CR后的运动负荷转换为MET。主要结局为全因死亡率，次要结局为HF住院。结果在707例患者中，CR开始和结束时的运动负荷中位数为2.5MET（IQR 2.1至3.1 METs）和3.2 METS（IQR 2.7至4.1 METs）分别为男性和2.2 METS（IQR 1.9至2.6 METs）和2.9 METS（IQR 2.3至3.4 METs）分别为女性。有242例死亡和266例HF住院。CR结束时达到的MET与全因死亡率（校正HR，95% CI：0.58，0.48-0.70）和HF住院（校正HR，95% CI：0.62，0.52-0.74）的独立相关性最强。CR结束时每增加1 MET的工作负荷，全因死亡率和HF住院的调整后风险分别降低42%和38%。结论在慢性HF患者的不同队列中，我们的数据表明，一种容易获得的运动能力测量方法（即，CR期间收集的METs）与全因死亡率和HF特异性住院的校正风险独立相关。MET级别的培训
Background In patients with coronary heart disease, the exercise workload (i.e., metabolic equivalents of task, METs) at which patients exercise train upon entry and completion of cardiac rehabilitation (CR) are independently related to prognosis. Unknown is the association between exercise training workloads in CR and clinical outcomes in patients with heart failure (HF).Methods Patients with HF who participated in an early outpatient CR program were used in this retrospective analysis. Exercise workloads upon entry and completion of CR were converted to METs. The primary outcome was all-cause mortality and the secondary outcome was HF hospitalization. Cox regression analysis was used to assess the adjusted risk between MET levels in CR and clinical outcomes.Results Among 707 patients, the median exercise training workload at the start and end of CR was 2.5 METs (IQR 2.1 to 3.1 METs) and 3.2 METS (IQR 2.7 to 4.1 METs), respectively, for men and 2.2 METs (IQR 1.9 to 2.6 METs) and 2.9 METS (IQR 2.3 to 3.4 METs), respectively, for women. There were 242 deaths and 266 HF hospitalizations. METs achieved at the end of CR had the strongest independent association with all-cause mortality (adjusted HR, 95% CI: 0.58, 0.48-0.70) and HF hospitalization (adjusted HR, 95% CI: 0.62, 0.52-0.74). Each 1 MET higher work load at the end of CR was associated with a 42% and 38% lower adjusted risk for all-cause mortality and HF hospitalization, respectively.Conclusions In a diverse cohort of patients with chronic HF our data suggests that an easily accessible measure of exercise capacity (i.e., METs) that is collected during CR is independently associated with the adjusted risk for both all-cause mortality and HF-specific hospitalization. Training at MET levels