Effect of atrial fibrillation on response to exercise-based cardiac rehabilitation in older individuals with heart failure
Effect of atrial fibrillation on response to exercise-based cardiac rehabilitation in older individuals with heart failure
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DOI：
10.1016/j.rehab.2020.101466
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发表时间：
2021-10-27
影响因子：
4.6
通讯作者：
Ako, Junya
中科院分区：
文献类型：
--
作者：
Hamazaki, Nobuaki;Kamiya, Kentaro;Ako, Junya
背景资料：虽然心力衰竭（HF）与心房颤动（AF）并存的患者预后较差，但老年HF患者AF状态与运动心脏康复（CR）后预后的相关性尚不清楚。目的：本回顾性研究旨在探讨AF对老年HF患者CR后身体功能变化和预后的影响。方法：我们招募了≥ 60岁的连续HF患者，他们接受了5个月的CR。基于锻炼的CR涉及为每位参与者量身定制的中等强度有氧运动。在基线和5个月后测量等长股四头肌力量（QS）和6分钟步行距离（6 MWD）作为身体功能。我们比较了QS和6 MWD从基线到5个月观察期的变化我们检查了5个月CR后全因死亡或计划外再入院的复合发生率，并分析了sicQS和sic 6 MWD与临床事件的相关性，估计了调整后的风险比（aHR）和95%置信区间（CI）。在764名参与者中，476名（62%）为窦性心律，288名（38%）为AF。AF与基线时较低的sicQS和sic 6 MWD相关。校正临床混杂因素后，两组的QS和6 MWD无差异。窦性心律时，QS和6 MWD的较大变化与临床事件发生率的降低显著相关（sicQS三分位数：aHR 0.75 [95% CI 0.60-0.92]; sic 6 MWD三分位数：aHR 0.59 [95% CI 0.46-0.76]）;然而，在AF中，仅观察到sic 6 MWD而非QS存在这种相关性（sicQS：aHR 0.92 [95%CI 0.72-1.17]; 6 MWD：aHR 0.73 [95%CI 0.54-0.98]）。结论：老年HF患者的AF与基线时身体功能下降相关，但对基于运动的CR无反应。此外，CR后身体功能的积极反应与更好的预后相关，无论是否患有AF，这表明基于运动的CR在患有HF和AF的老年人中可能有效。（C）2020 Elsevier Masson SAS。All rights reserved.
Background: Although the coexistence of heart failure (HF) with atrial fibrillation (AF) exhibits poor outcomes, the correlation between AF status and outcomes after exercise-based cardiac rehabilitation (CR) remains unclear in older individuals with HF.Objective: This retrospective study aimed to investigate the impact of AF on changes in physical function and prognosis after CR in older individuals with HF.Methods: We enrolled consecutive individuals with HF who were >= 60 years old who received 5-month CR. Exercise-based CR involved moderate-intensity aerobic exercises tailored to each participant. Isometric quadriceps strength (QS) and 6-min walk distance (6MWD) were measured as physical function, at baseline and 5 months thereafter. We compared QS and 6MWD changes from baseline to the 5-month observation period (sicQS and sic6MWD) between sinus rhythm and AF. We examined composite incidence of all-cause death or unplanned readmission after 5-month CR and analysed the association of sicQS and sic6MWD with clinical events, estimating adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).Results: Of the 764 participants, 476 (62%) had sinus rhythm, and 288 (38%) had AF. AF was associated with lower sicQS and sic6MWD at baseline. The 2 groups did not differ in QS and 6MWD after adjusting for clinical confounders. With sinus rhythm, greater change in QS and 6MWD was significantly associated with reduced incidence of clinical events (sicQS tertile: aHR 0.75 [95% CI 0.60-0.92]; sic6MWD tertile: aHR 0.59 [95% CI 0.46-0.76]); however, with AF, this association was observed for only sic6MWD and not QS (sicQS: aHR 0.92 [95% CI 0.72-1.17]; 6MWD: aHR 0.73 [95% CI 0.54-0.98]).Conclusion: AF in older individuals with HF is associated with reduced physical function at baseline but not response to exercise-based CR. Furthermore, positive response of physical function after CR is associated with better prognosis regardless of AF, which suggests that exercise-based CR is potentially effective in older individuals with HF and AF. (C) 2020 Elsevier Masson SAS. All rights reserved.