心力衰竭的心脏康复:证据和政策方面的进展与差距。

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Current Opinion in Cardiology Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI:10.1097/HCO.0000000000001129
Alfred Ngo-Hamilton, Dzhalal Agakishiev, Valmiki Maharaj
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引用次数: 0

摘要

综述目的:这篇综述综述了针对心力衰竭患者的心脏康复的疗效、最佳设计和实施方法的最新研究。尽管已经证实了心脏康复的益处,但转诊和就医方面的差异依然存在,因此有必要阐明其局限性和解决方案:最近的研究结果:以运动为基础的心脏康复可改善长期死亡率和住院率,但不能改善短期死亡率。然而,心脏康复依赖于面对面的服务,这在 COVID-19 期间加剧了获得服务的障碍。分析表明,目前的服务能力即使得到充分利用,也只能为 45% 符合条件的美国成年人提供服务。转诊率也很低,对妇女和少数民族群体的影响尤为严重。研究日益关注以家庭为基础的数字治疗模式,以扩大服务范围,有证据表明不同环境下的治疗效果具有可比性。尽管射血分数降低型心力衰竭(HFrEF)的发病率不断上升,但相关协议和研究仍以射血分数降低型心力衰竭(HFpEF)为中心。摘要:通过标准化程序增加转诊,并解决地理、经济和能力等多因素限制,是确保公平心脏康复的当务之急。扩大 HFpEF 康复研究和护理标准也是一个关键的实践差距,需要与预计的流行病学变化保持一致。推进以患者为中心、以证据为基础的解决方案可以促进康复成为更广泛心脏病人群的重要二级预防手段。视频摘要:http://links.lww.com/HCO/A97。
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Cardiac rehabilitation for heart failure: progress and gaps in evidence and policy.

Purpose of review: This review synthesizes recent research on the efficacy, optimal design, and delivery methods of cardiac rehabilitation tailored to heart failure patients. Despite established benefits, cardiac rehabilitation referral and access disparities persist, necessitating elucidation of limitations and solutions.

Recent findings: Exercise-based cardiac rehabilitation improves long-term mortality and hospitalization rates but not short-term mortality. cardiac rehabilitation further enhances quality of life and medical therapy adherence. However, cardiac rehabilitation relies on in-person delivery, presenting access barriers exacerbated during COVID-19. Significant geographic disparities exist, with analyses indicating current capacity only serves 45% of eligible US adults even if fully utilized. Referral rates also lag, disproportionately affecting women and minority groups. Research increasingly focuses on home-based and digital therapeutics modalities to expand reach, with evidence demonstrating comparable improvements across settings. Protocols and research center on heart failure with reduced ejection fraction (HFrEF), despite growing heart failure with preserved ejection fraction (HFpEF) prevalence.

Summary: Increasing referrals through standardized procedures and addressing multifactorial geographic, economic, and capacity limitations are imperative to ensure equitable cardiac rehabilitation access. Broadening HFpEF rehabilitation research and care standards also constitutes a critical practice gap requiring alignment with projected epidemiologic shifts. Advancing patient-centered, evidence-based solutions can promote rehabilitation as essential secondary prevention for wider cardiac populations.

Video abstract: http://links.lww.com/HCO/A97.

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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
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