The Benefits of Early Rehabilitation for Patients With Acute Heart Failure Requiring IV Inotropic Drugs.

IF 7.7 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2024-10-30 DOI:10.1097/CCM.0000000000006462

Kensuke Ueno, Hidehiro Kaneko, Kentaro Kamiya, Akira Okada, Masaaki Konishi, Teruhiko Imamura, Yuta Suzuki, Katsuhito Fujiu, Norifumi Takeda, Hiroyuki Morita, Junya Ako, Koichi Node, Hideo Yasunaga, Norihiko Takeda, Issei Komuro

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Abstract

Objectives: The benefits of early rehabilitation for patients with acute heart failure (HF) requiring IV inotropic drugs have yet to be determined. We investigated the association between early rehabilitation and short-term clinical outcomes in patients with acute HF requiring IV inotropic drugs.

Design: Retrospective cohort study.

Setting: This study used data including more than 90% of patients at a tertiary emergency hospital in Japan.

Patients: This study included patients with acute HF who required IV inotropic drugs within 2 days of admission.

Interventions: We compared patients who commenced rehabilitation within 2 days of admission (the early rehabilitation group) and those who did not (the control group).

Measurements and main results: Propensity score matching was used to compare in-hospital mortality, 30-day all-cause and HF readmissions, length of stay, and Barthel Index (BI) at discharge between patients who received early rehabilitation and those who did not. Totally, 38,302 patients were eligible for inclusion; of these, 5,127 received early rehabilitation and 5,126 pairs were generated by propensity score matching. After propensity score matching, the patients who received early rehabilitation had a lower in-hospital mortality rate than those who did not (9.9% vs. 13.2%; p < 0.001). The relative risk (95% CI) of early rehabilitation for in-hospital mortality was 0.75 (0.67-0.83). Patients undergoing early rehabilitation exhibited a shorter mean length of stay (25.5 vs. 27.1; p < 0.001), lower 30-day all-cause (14.1% vs. 16.4%; p = 0.001) and HF (8.6% vs. 10.4%; p = 0.002) readmissions, and higher BI scores at discharge (68 vs. 67; p = 0.096). Consistent findings were observed across subgroups, including in patients 80 years old or older, those with a body mass index less than 18.5 kg/m2, and those with BI scores less than 60.

Conclusions: The early prescription of rehabilitation was associated with favorable short-term outcomes even for patients with acute HF requiring IV inotropic drugs.

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需要静脉注射肌力药物的急性心力衰竭患者早期康复的益处。

目的：需要静脉注射肌力药物的急性心力衰竭（HF）患者早期康复的益处尚未确定。我们研究了需要静脉注射肌力药物的急性心力衰竭患者早期康复与短期临床结果之间的关系：设计：回顾性队列研究：本研究使用了日本一家三级急诊医院 90% 以上患者的数据：本研究包括入院 2 天内需要静脉注射肌力药物的急性心房颤动患者：干预措施：我们对入院2天内开始康复治疗的患者（早期康复组）和未开始康复治疗的患者（对照组）进行了比较：采用倾向得分匹配法比较了接受早期康复治疗和未接受早期康复治疗患者的院内死亡率、30 天全因再入院率和高血压再入院率、住院时间和出院时的 Barthel 指数（BI）。共有 38,302 名患者符合纳入条件，其中 5,127 人接受了早期康复治疗，5,126 对患者通过倾向得分匹配产生。经过倾向评分匹配后，接受早期康复治疗的患者的院内死亡率低于未接受康复治疗的患者（9.9% 对 13.2%；P < 0.001）。早期康复对院内死亡率的相对风险（95% CI）为0.75（0.67-0.83）。接受早期康复治疗的患者平均住院时间较短（25.5 对 27.1；p < 0.001），30 天全因（14.1% 对 16.4%；p = 0.001）和高频（8.6% 对 10.4%；p = 0.002）再入院率较低，出院时 BI 评分较高（68 对 67；p = 0.096）。不同亚组的研究结果一致，包括 80 岁或以上的患者、体重指数低于 18.5 kg/m2 的患者以及 BI 评分低于 60 分的患者：结论：即使是需要静脉注射肌力药物的急性心房颤动患者，早期康复处方也与良好的短期疗效相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.