Predictors of long-term prognosis based on measurements achieved after 9-week hybrid telerehabilitation in heart failure patients – a subanalyis of the TELEREH-HF RCT

Autor: E Piotrowicz, M Pencina, I Kowalik, P Orzechowski, M Banach, R Glowczynska, W Zareba, G Opolski, D Szalewska, S Pluta, Z Kalarus, R Irzmanski, R Piotrowicz
Rok vydání: 2022
Předmět:
Zdroj: European Heart Journal. 43
ISSN: 1522-9645
0195-668X
DOI: 10.1093/eurheartj/ehac544.991
Popis: Background Predicting prognosis in heart failure (HF) is of major importance. The purpose of the study was to define predictors influencing long-term cardiovascular mortality or HF hospitalization (“composite outcome”) based on clinical status and measurements obtained after the 9-week hybrid comprehensive telerehabilitation (HCTR) programme. Methods This analysis is based on TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III; left ventricular ejection fraction [LVEF]≤40%). Patients were randomized 1:1 to 9-week HCTR plus usual care (development sample) or usual care only (validation sample) and followed for 12–24 months for development of the composite. Results The predictors of our composite were: non-ischaemic etiology of HF, diabetes, higher serum level of: N-terminal prohormone of brain natriuretic peptide, creatinine, and high-sensitivity C-Reactive Protein; low carbon dioxide output at peak exercise, high minute ventilation and breathing frequency at maximum effort in cardiopulmonary test; increase of delta of average heart rate in 24h-ECG Holter monitoring, lower LVEF and patients' non-adherence to HCTR. The model discrimination C-index=0.795 and decreased to 0.755 on validation (Table 1). The 2-year risk of the composite was 48% in the top tertile versus 5% in the bottom tertile (Figure 1). Conclusion Risk factors collected at the end of the 9-week telerehabilitaion period did an excellent job in stratifying patients based on their 2-year risk of the composite outcome. Patients in the top tertile had an almost ten-fold higher risk compared to patients in the bottom tertile. Adherence to treatment but not peakVO2 or quality of life were significantly associated with the outcome. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Centre for Research and Development, Warsaw, Poland
Databáze: OpenAIRE
Externí odkaz: