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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Trends and Outcomes of Early Rehabilitation in the Intensive Care Unit for Patients With Cardiovascular Disease: A
Nobuaki Hamazaki1, Kentaro Kamiya2, Kohei Nozaki1
1Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan.
Insights
Early cardiovascular rehabilitation (CR) in the intensive care unit (ICU) improves walking independence and reduces hospital readmissions for cardiovascular disease (CVD) patients. This critical intervention enhances both in-hospital and long-term patient outcomes.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Rehabilitation Medicine
Background:
- The effectiveness of acute-phase cardiovascular rehabilitation (CR) in intensive care settings for cardiovascular disease (CVD) patients is not well-established.
- Investigating trends and outcomes of CR within the intensive care unit (ICU) is crucial for optimizing patient care.
Purpose of the Study:
- To examine the trends in acute-phase CR implementation in the ICU for CVD patients.
- To evaluate the impact of ICU-CR on in-hospital and long-term clinical outcomes.
Main Methods:
- A retrospective cohort study of 1,948 CVD patients admitted to a tertiary academic ICU.
- Propensity score-matched analysis comparing patients who received ICU-CR versus those who did not.
- Endpoints included in-hospital walking independence, return home, and 5-year post-discharge all-cause readmission or cardiovascular events.
Main Results:
- ICU-CR implementation showed a significant increasing trend over time (p<0.001).
- Propensity score matching included 379 pairs of patients.
- ICU-CR was associated with significantly higher walking independence (RR 2.04) and return home rates (RR 1.22).
- ICU-CR also demonstrated significantly lower incidences of all-cause (HR 0.71) and cardiovascular events (HR 0.69) at 5 years.
Conclusions:
- Acute-phase CR in the ICU is increasingly implemented and demonstrates significant benefits.
- ICU-CR improves both in-hospital functional recovery and long-term clinical outcomes for CVD patients.
- These benefits were consistent across various subgroups, including elderly patients and those with complex ICU stays.
Background:
The effectiveness of acute-phase cardiovascular rehabilitation (CR) in intensive care settings remains unclear in patients with cardiovascular disease (CVD). This study aimed to investigate the trends and outcomes of acute-phase CR in the intensive care unit (ICU) for patients with CVD, including in-hospital and long-term clinical outcomes.
Method:
This retrospective cohort study reviewed a total of 1,948 consecutive patients who were admitted to a tertiary academic ICU for CVD treatment and underwent CR during hospitalisation. The endpoints of this study were the following: in-hospital outcomes: probabilities of walking independence and returning home; and long-term outcomes: clinical events 5 years following hospital discharge, including all-cause readmission or cardiovascular events. It evaluated the associations of CR implementation during ICU treatment (ICU-CR) with in-hospital and long-term outcomes using propensity score-matched analysis.
Results:
Among the participants, 1,092 received ICU-CR, the rate of which tended to increase with year trend (p for trend <0.001). After propensity score matching, 758 patients were included for analysis (pairs of n=379 ICU-CR and non-ICU-CR). ICU-CR was significantly associated with higher probabilities of walking independence (rate ratio, 2.04; 95% CI 1.77-2.36) and returning home (rate ratio, 1.22; 95% CI 1.05-1.41). These associations were consistently observed in subgroups aged >65 years, after surgery, emergency, and prolonged ICU stay. ICU-CR showed significantly lower incidences of all-cause (HR 0.71; 95% CI 0.56-0.89) and cardiovascular events (HR 0.69; 95% CI 0.50-0.95) than non-ICU-CR.
Conclusions:
The implementation of acute-phase CR in ICU increased with year trend, and is considered beneficial to improving in-hospital and long-term outcomes in patients with CVD and various subgroups.
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