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Trends and Outcomes of Early Rehabilitation in the Intensive Care Unit for Patients With Cardiovascular Disease: A Cohort Study With Propensity Score-Matched Analysis - 06/11/23

Doi : 10.1016/j.hlc.2023.05.023 
Nobuaki Hamazaki, PT, PhD a, , Kentaro Kamiya, PT, PhD b, Kohei Nozaki, PT, PhD a, Tomotaka Koike, PT, PhD c, Kazumasa Miida, PT, MSc a, Masashi Yamashita, PT, PhD d, Shota Uchida, PT, PhD d, Takumi Noda, PT, MSc d, Emi Maekawa, MD, PhD e, Minako Yamaoka-Tojo, MD, PhD b, Atsuhiko Matsunaga, PT, PhD b, Masayasu Arai, MD, PhD f, Tadashi Kitamura, MD, PhD g, Junya Ako, MD, PhD e, Kagami Miyaji, MD, PhD g
a Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan 
b Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan 
c Department of Intensive Care, Kitasato University Hospital, Sagamihara, Kanagawa, Japan 
d Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan 
e Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 
f Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 
g Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 

Address for Correspondence: Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, JapanDepartment of RehabilitationKitasato University Hospital1-15-1 KitasatoMinami-kuSagamiharaKanagawa252-0375Japan

Abstract

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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Keywords : Early rehabilitation, Cardiovascular disease, Intensive care, Long-term outcomes


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© 2023  Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 32 - N° 10

P. 1240-1249 - octobre 2023 Retour au numéro
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