ABSTRACT
Background: Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. Methods: In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. Results: Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308-0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). Conclusions: Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation.
ABSTRACT
OBJECTIVES: Physical therapy improves outcomes for patients with head and neck cancer (HNC) but home-based program (HBP) has not yet been investigated thoroughly. This study compared a HBP with outpatient physical therapy (OPT). METHODS: This trial categorized patients with primary HNC into OPT and HBP groups. The patients in the HBP group received home-based therapy once a day for 5â¯days per week. By contrast, the OPT group received various physical therapies, including aerobic, anaerobic, and stretching therapies, twice per week, plus a thrice-weekly home-based therapy that similarly consisted of aerobic, anaerobic, and stretching exercises. The major outcome was the Functional Assessment of Cancer Therapy-Head and Neck (FACT H&N), and secondary outcomes were the visual analog scale (VAS) of shoulder pain, 6-min walking test (6MWT), and shoulder range of motion (ROM), all of which were evaluated before, during, and after interventions. RESULTS: Significant improvements were found after 12 weeks of the HBP or OPT. The HBP was not inferior to OPT regarding FACT H&N (p=.074), VAS of shoulder pain (p=.677), 6MWT (p = .677), and shoulder ROM (p=.145 for flexion; p=.383 for abduction). CONCLUSIONS: Both the HBP and OPT can improve shoulder abduction, shoulder flexion and functional capacity.
