对心力衰竭的成年人进行基于运动的心脏康复
Cal Molloy1, Linda Long2, Ify R Mordi3
1College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
The Cochrane database of systematic reviews
|March 7, 2024
概括
基于运动的心脏康复 (ExCR) 可能会减少住院和改善心力衰竭患者的生活质量,但不会对死亡率产生重大影响. 这次更新的审查支持各种ExCR交付方法,包括基于家庭的程序.
科学领域:
- 心脏病学和运动科学
- 心脏衰竭管理的管理
- 康复医学 康复医学 康复医学
背景情况:
- 心力衰竭 (HF) 带来了巨大的负担,影响了运动耐受性,生活质量 (QoL),增加了死亡率和住院风险.
- 之前的审查表明,基于运动的心脏康复 (ExCR) 改善了QoL,并减少了HF患者的住院治疗,这可能会对长期死亡率产生好处.
- 之前研究的局限性包括女性,老年人和心力衰竭患者的代表性不足,以及专注于以中心为基础的计划.
研究的目的:
- 评估基于运动的心脏康复 (ExCR) 对心力衰竭 (HF) 的成年人死亡率,住院和与健康相关的生活质量 (HRQoL) 的影响.
- 综合来自随机对照试验 (RCT) 的证据,将ExCR与无运动对照进行比较.
- 评估ExCR效应在不同患者群体和分娩环境中的一致性.
主要方法:
- 在2021年12月之前,对多个电子数据库 (CENTRAL,MEDLINE,Embase,CINAHL,PsycINFO,Web of Science) 进行了全面的搜索.
- 包括60个RCT (8728名参与者) 与至少六个月的随访,比较ExCR干预与心力衰竭 (HFrEF或HFpEF) 的成年人没有运动对照.
- 主要结局包括全因死亡率,高风特异性死亡率,全因住院人数,高风相关住院人数和HRQoL,分析使用标准的柯克林方法和GRADE以确定证据.
主要成果:
- 在短期内,ExCR和常规护理之间没有观察到任何原因死亡率的显著差异 (低确定性证据).
- 参与ExCR可能会降低所有原因住院的风险 (中等确定性证据) 和与心力衰竭相关的住院风险 (中等确定性证据).
- ExCR可能改善了短期HRQoL,在各种交付模式中观察到一致的好处,包括家庭和综合计划 (中等到非常低的确定性证据).
结论:
- 此次更新的综述证实,ExCR与心力衰竭患者的住院减少和HRQoL改善有关,但对短期死亡率没有明显影响.
- 证据支持各种ExCR交付方法的有效性,包括家庭和数字支持的程序,扩大可访问性.
- 未来的研究应该优先考虑招募代表性不足的群体,如老年人,妇女和高高压的个人,以确保ExCR福利的更广泛适用性.
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