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Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study
BACKGROUND: Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. ME...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039246/ https://www.ncbi.nlm.nih.gov/pubmed/35498011 http://dx.doi.org/10.3389/fcvm.2022.763217 |
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author | Chen, Shyh-Ming Wang, Lin-Yi Liaw, Mei-Yun Wu, Ming-Kung Wu, Po-Jui Wei, Chin-Ling Chen, An-Ni Su, Tsui-Ling Chang, Jui-Kun Yang, Tsung-Hsun Chen, Ching Cheng, Cheng-I Chen, Po-Cheng Chen, Yung-Lung |
author_facet | Chen, Shyh-Ming Wang, Lin-Yi Liaw, Mei-Yun Wu, Ming-Kung Wu, Po-Jui Wei, Chin-Ling Chen, An-Ni Su, Tsui-Ling Chang, Jui-Kun Yang, Tsung-Hsun Chen, Ching Cheng, Cheng-I Chen, Po-Cheng Chen, Yung-Lung |
author_sort | Chen, Shyh-Ming |
collection | PubMed |
description | BACKGROUND: Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. METHODS: In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. RESULTS: Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308–0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). CONCLUSIONS: Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation. |
format | Online Article Text |
id | pubmed-9039246 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90392462022-04-27 Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study Chen, Shyh-Ming Wang, Lin-Yi Liaw, Mei-Yun Wu, Ming-Kung Wu, Po-Jui Wei, Chin-Ling Chen, An-Ni Su, Tsui-Ling Chang, Jui-Kun Yang, Tsung-Hsun Chen, Ching Cheng, Cheng-I Chen, Po-Cheng Chen, Yung-Lung Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. METHODS: In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. RESULTS: Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308–0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). CONCLUSIONS: Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation. Frontiers Media S.A. 2022-04-12 /pmc/articles/PMC9039246/ /pubmed/35498011 http://dx.doi.org/10.3389/fcvm.2022.763217 Text en Copyright © 2022 Chen, Wang, Liaw, Wu, Wu, Wei, Chen, Su, Chang, Yang, Chen, Cheng, Chen and Chen. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Chen, Shyh-Ming Wang, Lin-Yi Liaw, Mei-Yun Wu, Ming-Kung Wu, Po-Jui Wei, Chin-Ling Chen, An-Ni Su, Tsui-Ling Chang, Jui-Kun Yang, Tsung-Hsun Chen, Ching Cheng, Cheng-I Chen, Po-Cheng Chen, Yung-Lung Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study |
title | Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study |
title_full | Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study |
title_fullStr | Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study |
title_full_unstemmed | Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study |
title_short | Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study |
title_sort | outcomes with multidisciplinary cardiac rehabilitation in post-acute systolic heart failure patients—a retrospective propensity score-matched study |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039246/ https://www.ncbi.nlm.nih.gov/pubmed/35498011 http://dx.doi.org/10.3389/fcvm.2022.763217 |
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