心房颤动患者射频消融术后居家运动康复强度-时间依从性轨迹及预测因素的纵向研究

Development Trajectory and Predictors of Strength-duration Adherence to Home-based Exercise Rehabilitation among Patients with Atrial Fibrillation after Radiofrequency Catheter Ablation:a Longitudinal Study

背景我国心房颤动(以下简称房颤)患病率逐年升高,患者的预后及生活质量亟需关注。现有研究证实运动康复是改善房颤射频消融术后患者预后及生活质量不佳的有效方式。依从性是衡量运动康复益处是否持续存在的关键指标,但其变化轨迹未知。目的基于前瞻性纵向观察的心房颤动患者射频消融术后居家运动康复强度-时间依从性5期追踪数据,考察发展轨迹及预测因素。方法采用便利抽样法,选取2020年5—11月就诊于南京医科大学第一附属医院心血管内科行射频消融术的246例房颤患者为研究对象进行随访。其中入组1周为基线调查,入组后3、6、9个月和12个月为追踪调查。收集患者的一般资料;本研究使用智能设备或运动日志对依从性进行监督和记录,从强度-时间依从性评估运动依从性;采用运动自我效能量表(SEE)、运动恐惧量表(Fact-CHF)、领悟社会支持量表(PSSS)、患者积极度量表(PAM13)分别评估患者的运动自我效能、运动恐惧水平、社会支持情况、积极度水平。利用Mplus工具构建潜类别增长模型(LCGM),取最优的拟合模型确定房颤患者射频消融术后居家运动康复强度-时间依从性的发展轨迹,采用Logistic回归分析识别轨迹类别的预测因素。结果44例患者失访,最终共202例纳入分析。基线、运动3个月、运动6个月、运动9个月、运动12个月患者例数分别为202、201、185、174例和159例,患者强度-时间依从性分别为(0.83±0.55)、(1.07±0.54)、(0.99±0.57)、(0.91±0.55)、(0.89±0.60)。LCGM结果显示,患者的运动康复强度-时间依从性变化过程具有群体异质性,分为3个潜类别轨迹组:缓慢下降-低水平组(n=69,34.2%)、快速上升-高水平组(n=14,6.9%)、持续依从组(n=119,58.9%)。无序多分类Logistic回归分析结果显示,以缓慢下降-低水平组为参照组,快速上升-高水平组和持续依从组男性患者的强度-时间依从性水平更高(P<0.001);快速上升-高水平组和持续依从组患者的年龄更大,运动自我效能水平更高(P<0.05);快速上升-高水平组患者的运动恐惧水平更低(P<0.05);持续依从组患者的积极度水平更高(P<0.05)。结论房颤患者射频消融术后居家运动康复强度-时间依从性呈多类别曲线增长的发展轨迹;未来可依据依从性的时变特点和因素定期进行强化干预,进而提高患者居家运动康复依从性水平且保持稳定。

Background The prevalence of atrial fibrillation(AF)in China is increasing year by year,and the prognosis and quality of life of patients urgently need attention.Current studies have confirmed that exercise rehabilitation is a beneficial way to improve the prognosis and poor quality of life in patients with AF after radiofrequency catheter ablation(RFCA).Adherence is a key measure of whether the benefits of exercise rehabilitation persist,but its trajectory remains unknown.Objective To examine the development trajectory and predictors of strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA using five-period follow-up data based on prospective longitudinal observation.Methods Convenience sampling method was used to select 246 patients with AF who attended the Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University for RFCA from May to November 2020 for follow-up.The baseline survey was conducted 1 week after enrollment,and the follow-up survey was conducted at 3,6,9 and 12 months after enrollment.The general and clinical data of patients were collected.The strength-duration adherence was monitored and recorded using smart devices or fitness log to assess exercise adherence in terms of strength-duration adherence;Self-efficacy for Exercise Scale(SEE),Fear of Activity in Patients with Chronic Heart Failure(Fact-CHF),Perceived Social Support Scale(PSSS),Patient Activation Measure 13(PAM13)were used for assessing self-efficacy of exercise,fear of activity,social support and motivation level.Mplus tool was used to construct latent class growth model(LCGM),and the optimal fitting model was selected to determine the development trajectory of strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA.Logistic regression analysis was used to identify the predictors of trajectory categories.Results A total of 202 patients were included in the final analysis with 44 patients lost to follow-up.The number of patients at baseline,3 months,6 months,9 months,and 12 months after exercise were 202,201,185,174 and 159,respectively,and the strength-duration adherence were(0.83±0.55),(1.07±0.54),(0.99±0.57),(0.91±0.55)and(0.89±0.60).The LCGM results showed group heterogeneity in the process of change in strength-duration adherence to exercise rehabilitation in patients,which was divided into 3 latent classes based on their development trajectories,including 69 in slow decline-low level group(34.2%),14 in rapid increase-high level group(6.9%),and 119 in sustained adherence group(58.9%).Multinomial unordered Logistic regression showed higher levels of intensity-time adherence in the rapid increase-high level group and sustained adherence group using the slow decline-low level group as the reference group(P<0.001).The patients in the rapid increase-high level group and sustained adherence group were older,with higher level of exercise self-efficacy(P<0.05).The level of fear of activity was lower in the rapid increase-high level group,and the level of activation was higher in the sustained adherence group(P<0.05).Conclusion The strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA showed a multi-class curve growth trajectory.In the future,intensive interventions can be conducted periodically according to the time-varying characteristics and predictors,to improve and stabilize the adherence to home-based exercise rehabilitation.