美国维克森林大学医学院Dalane W. Kitzman团队研究了老年心力衰竭住院患者的物理康复效果。2021年5月16日，该成果发表在《新英格兰医学杂志》上。

因急性失代偿性心力衰竭住院的老年患者身体虚弱、生活质量差、恢复延迟、经常再住院的概率较大。解决这一人群身体虚弱的干预措施尚未很好地建立起来。

研究组进行了一项多中心、随机、对照试验，以评估过渡、量身定制、渐进式康复干预，对包括四个身体功能领域（力量、平衡、移动性和耐力）的影响。患者在心力衰竭住院期间或住院后早期开始干预，出院后继续进行36次门诊治疗。主要结局是3个月时的简易机体功能评估（SPPB，0-12分，分数越低表示身体功能越差）。次要结局是6个月内的全因再住院率。

共有349例患者接受随机分组，其中175人接受康复干预，174人接受常规护理（对照组）。在基线检查时，各组患者的身体功能均明显受损，97%的患者体弱多病，两组的平均共存症状为5条。干预组的患者保留率为82%，坚持干预疗程的比例为67%。在对基线SPPB进行校正后，干预组3个月时的最小二乘平均值为8.3分，对照组为6.9分。6个月时，干预组的全因再住院率为1.18，对照组为1.28。干预组死亡21例（心血管原因15例），对照组死亡16例（心血管原因8例）。全因死亡率分别为0.13和0.10，优势比为1.17。

研究结果表明，在因急性失代偿性心力衰竭住院的老年患者的不同人群中，早期、过渡性、量身定制、渐进的康复干预，包括多个生理功能领域，比常规护理对生理功能的改善更大。

附：英文原文

Title: Physical Rehabilitation for Older Patients Hospitalized for Heart Failure | NEJM

Author: Dalane W. Kitzman, M.D.,, David J. Whellan, M.D., M.H.S.,, Pamela Duncan, P.T., Ph.D.,, Amy M. Pastva, P.T., Ph.D.,, Robert J. Mentz, M.D.,, Gordon R. Reeves, M.D., M.P.T.,, M. Benjamin Nelson, M.S.,, Haiying Chen, Ph.D.,, Bharathi Upadhya, M.D.,, Shelby D. Reed, Ph.D.,, Mark A. Espeland, Ph.D.,, LeighAnn Hewston, D.P.T., M.Ed.,, and Christopher M. O’Connor, M.D.

Issue&Volume: 2021-05-16

Abstract:

Background

Older patients who are hospitalized for acute decompensated heart failure have high rates of physical frailty, poor quality of life, delayed recovery, and frequent rehospitalizations. Interventions to address physical frailty in this population are not well established.

Methods

We conducted a multicenter, randomized, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was initiated during, or early after, hospitalization for heart failure and was continued after discharge for 36 outpatient sessions. The primary outcome was the score on the Short Physical Performance Battery (total scores range from 0 to 12, with lower scores indicating more severe physical dysfunction) at 3 months. The secondary outcome was the 6-month rate of rehospitalization for any cause.

Results

A total of 349 patients underwent randomization; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, patients in each group had markedly impaired physical function, and 97% were frail or prefrail; the mean number of coexisting conditions was five in each group. Patient retention in the intervention group was 82%, and adherence to the intervention sessions was 67%. After adjustment for baseline Short Physical Performance Battery score and other baseline characteristics, the least-squares mean (±SE) score on the Short Physical Performance Battery at 3 months was 8.3±0.2 in the intervention group and 6.9±0.2 in the control group (mean between-group difference, 1.5; 95% confidence interval [CI], 0.9 to 2.0; P<0.001). At 6 months, the rates of rehospitalization for any cause were 1.18 in the intervention group and 1.28 in the control group (rate ratio, 0.93; 95% CI, 0.66 to 1.19). There were 21 deaths (15 from cardiovascular causes) in the intervention group and 16 deaths (8 from cardiovascular causes) in the control group. The rates of death from any cause were 0.13 and 0.10, respectively (rate ratio, 1.17; 95% CI, 0.61 to 2.27).

Conclusions

In a diverse population of older patients who were hospitalized for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care.

DOI: 10.1056/NEJMoa2026141

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2026141