心臓リハビリテーション介入と運動機能改善および医療費削減効果の関係

• Project/Area Number: 18K17715
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 59010:Rehabilitation science-related
• Research Institution: Shinshu University
• Principal Investigator: 山本 周平 信州大学, 医学部附属病院, 理学療法士 (10784481)
• Project Period (FY): 2018-04-01 – 2024-03-31
• Project Status: Granted (Fiscal Year 2022)
• Budget Amount: ¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000); Fiscal Year 2021: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2020: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2019: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2018: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
• Keywords: リハビリテーション / 心臓 / 心不全 / 身体機能 / 再入院 / 運動機能 / 運動耐容能 / 日常生活動作 / 循環器 / 予防

Outline of Annual Research Achievements

本研究の目的は、心疾患患者に対するリハビリテーションの実施によって、再入院率の減少と医療費削減効果について明らかにすることである。本年度の研究では、昨年度に引き続き対象患者をフォローアップしていく段階である。
退院後に心臓リハビリが処方された18歳以上の心疾患患者として、握力、等尺性膝伸展筋力、short physical performance battery (SPPB)、片脚立位時間、歩行速度および運動耐容能（6分間歩行試験）を評価した。ベースラインの取り込みは105例終了し、3ー4ヶ月後の測定まで実施出来ている症例は51例である。運動機能が低下した症例の特徴をまとめ、フォローアップで医療費データの追跡調査を行っている段階である。

Current Status of Research Progress

3: Progress in research has been slightly delayed.

Reason

本研究の主目的は「心疾患患者の運動機能の改善が再入院率の低下ならびに医療費の削減に寄与するか」を証明することである。研究1では運動機能の改善と再入院率の関係を明らかにするために、ベースラインとなる運動機能やADL、運動耐容能評価を行った。心疾患患者を対象として、入院期間中の心臓リハビリテーションによって運動機能やADLが改善した群と改善しなかった群を比較した。その結果、入院期間中にADLが改善した群の方が改善しなかった群と比較して退院後の再入院率や死亡率が低いことが明らかとなった。

昨年度に引き続き、外来にてフォローアップを行い、運動機能や運動耐容能が改善した群とそうでない群の特徴をまとめてフォローアップを行っている段階である。しかし、COVID-19の影響で外来リハビリを中止した期間があり、症例数が伸びておらず、現在までの進捗状況を「やや遅れている」と判断した。現状で症例の取り込みは完了したため、あとは医療費のフォローアップを行う段階である。

Strategy for Future Research Activity

現在、当院の外来心臓リハビリテーションが処方された18歳以上の虚血性心疾患患者とし６分間歩行試験の結果を中央値をもとに改善群と非改善の２群に分類した。改善群の平均年齢は60.6歳、非改善群は69.3歳である。ベースラインの6分間歩行試験の結果は、改善群が４２４．９m、非改善群が511.5mであった。現在、医療費データを集めている段階である。

Research Products

• [Journal Article] Prevalence and prognostic impact of the coexistence of cachexia and sarcopenia in older patients with heart failure (2023)
  • Author(s): Fujimoto Y、Maeda D、Kagiyama N、Sunayama T、Dotare T、Jujo K、Saito K、Kamiya K、Saito H、Ogasahara Y、Maekawa E、Konishi M、Kitai T、Iwata K、Wada H、Hiki M、Kasai T、Nagamatsu H、Ozawa T、Izawa K、Yamamoto S、Aizawa N、Wakaume K、Oka K、Momomura S、Matsue Y
  • Journal Title: International Journal of Cardiology Volume: 381 Pages: 45-51
  • DOI: 10.1016/j.ijcard.2023.03.035
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Prognostic implications of six-minute walking distance in patients with heart failure with preserved ejection fraction (2023)
  • Author(s): Fujimoto Y、Maeda D、Kagiyama N、Sunayama T、Dotare T、Jujo K、Saito K、Kamiya K、Saito H、Ogasahara Y、Maekawa E、Konishi M、Kitai T、Iwata K、Wada H、Hiki M、Kasai T、Nagamatsu H、Ozawa T、Izawa K、Yamamoto S、Aizawa N、Wakaume K、Oka K、Momomura S、Matsue Y
  • Journal Title: International Journal of Cardiology Volume: 379 Pages: 76-81
  • DOI: 10.1016/j.ijcard.2023.03.025
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Sarcopenic obesity is associated with impaired physical function and mortality in older patients with heart failure: insight from FRAGILE-HF (2022)
  • Author(s): Saito Hiroshi、Matsue Yuya、Kamiya Kentaro、Kagiyama Nobuyuki、Kasai Takatoshi、et al.
  • Journal Title: BMC Geriatrics Volume: 22 Issue: 1 Pages: 556-556
  • DOI: 10.1186/s12877-022-03168-3
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Prevalence and prognostic impact of cognitive frailty in elderly patients with heart failure: sub‐analysis of FRAGILE‐HF (2022)
  • Author(s): Yamamoto Shuhei、Yamasaki Saeko、Kasai Takatoshi、et al.
  • Journal Title: ESC Heart Failure Volume: 9 Issue: 3 Pages: 1574-1583
  • DOI: 10.1002/ehf2.13844
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Inaccurate recognition of own comorbidities is associated with poor prognosis in elderly patients with heart failure (2022)
  • Author(s): Maeda Daichi、Matsue Yuya、et al.
  • Journal Title: ESC Heart Failure Volume: 9 Issue: 2 Pages: 1351-1359
  • DOI: 10.1002/ehf2.13824
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Work status before admission relates to prognosis in older patients with heart failure partly through social frailty (2022)
  • Author(s): Yamashita Masashi、Kamiya Kentaro、Hamazaki Nobuaki、Nozaki Kohei、et al.
  • Journal Title: Journal of Cardiology Volume: 79 Issue: 3 Pages: 439-445
  • DOI: 10.1016/j.jjcc.2021.10.029
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Sex differences in the prevalence and prognostic impact of physical frailty and sarcopenia among older patients with heart failure (2022)
  • Author(s): Maeda Daichi、Matsue Yuya、Kagiyama Nobuyuki、Jujo Kentaro、Saito Kazuya、Kamiya Kentaro、Saito Hiroshi、Ogasahara Yuki、Maekawa Emi、Konishi Masaaki、Kitai Takeshi、Iwata Kentaro、Wada Hiroshi、Hiki Masaru、Dotare Taishi、Sunayama Tsutomu、Kasai Takatoshi、Nagamatsu Hirofumi、Ozawa Tetsuya、Izawa Katsuya、et al.
  • Journal Title: Nutrition, Metabolism and Cardiovascular Diseases Volume: 32 Issue: 2 Pages: 365-372
  • DOI: 10.1016/j.numecd.2021.10.012
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Impact of physical performance on exercise capacity in older patients with heart failure with reduced and preserved ejection fraction (2021)
  • Author(s): Saka Kenichiro、Konishi Masaaki、Kagiyama Nobuyuki、Kamiya Kentaro、Saito Hiroshi、Saito Kazuya、Ogasahara Yuki、Maekawa Emi、Misumi Toshihiro、Kitai Takeshi、Iwata Kentaro、Jujo Kentaro、Wada Hiroshi、Kasai Takatoshi、Nagamatsu Hirofumi、Ozawa Tetsuya、Izawa Katsuya、Yamamoto Shuhei、Aizawa Naoki、et al.
  • Journal Title: Experimental Gerontology Volume: 156 Pages: 111626-111626
  • DOI: 10.1016/j.exger.2021.111626
  • Peer Reviewed
• [Journal Article] Impact of Social Frailty in Hospitalized Elderly Patients With Heart Failure: A FRAGILE‐HF Registry Subanalysis (2021)
  • Author(s): Jujo Kentaro、Matsue Yuya、et al.
  • Journal Title: Journal of the American Heart Association Volume: 10 Issue: 17
  • DOI: 10.1161/jaha.120.019954
  • Peer Reviewed / Open Access
• [Journal Article] Decreased activities of daily living at discharge predict mortality and readmission in elderly patients after cardiac and aortic surgery (2021)
  • Author(s): Sato Masaaki、Mutai Hitoshi、Yamamoto Shuhei、Tsukakoshi Daichi、Takeda Shuhei、Oguchi Natsuko、Ichimura Hajime、Ikegami Shota、Wada Yuko、Seto Tatsuichiro、Horiuchi Hiroshi
  • Journal Title: Medicine Volume: 100 Issue: 31 Pages: e26819-e26819
  • DOI: 10.1097/md.0000000000026819
  • Peer Reviewed / Open Access
• [Journal Article] Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure (2021)
  • Author(s): Maeda Daichi、Matsue Yuya、et al.
  • Journal Title: Scientific Reports Volume: 11 Issue: 1
  • DOI: 10.1038/s41598-021-91368-z
  • Peer Reviewed / Open Access
• [Journal Article] Validity and Utility of the Questionnaire-based FRAIL Scale in Older Patients with Heart Failure: Findings from the FRAGILE-HF (2021)
  • Author(s): Nozaki K, Kamiya K, Hamazaki N, Saito H, Saito K, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Jujo K, Wada H, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Makino A, Oka K, Momomura SI, Kagiyama N, Matsue Y.
  • Journal Title: J Am Med Dir Assoc Volume: － Issue: 8 Pages: 1621-1626.e2
  • DOI: 10.1016/j.jamda.2021.02.025
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] The modified water swallowing test score is the best predictor of postoperative pneumonia following extubation in cardiovascular surgery (2021)
  • Author(s): Oguchi Natsuko、Yamamoto Shuhei、Terashima Satsuki、Arai Ruka、Sato Masaaki、Ikegami Shota、Horiuchi Hiroshi
  • Journal Title: Medicine Volume: 100 Issue: 4 Pages: e24478-e24478
  • DOI: 10.1097/md.0000000000024478
• [Journal Article] Prophylactic cranial irradiation for extensive-stage small cell lung cancer (2021)
  • Author(s): Nishie Kenichi、Yamamoto Shuhei、Yamaga Takayoshi、Horita Nobuyuki、Mori Rintaro、Gouda Mohamed A、Hanaoka Masayuki
  • Journal Title: Cochrane Database of Systematic Reviews Volume: non
  • DOI: 10.1002/14651858.cd014559
  • Peer Reviewed / Open Access
• [Journal Article] Cochrane corner: Positive airway pressure therapy for the treatment of central sleep apnoea associated with heart failure (2021)
  • Author(s): Yamamoto Shuhei、Yamaga Takayoshi、Kawachi Shohei、Shibuya Manaka、Nishie Kenichi
  • Journal Title: Heart Volume: 107 Issue: 7 Pages: 525-527
  • DOI: 10.1136/heartjnl-2020-317888
  • Peer Reviewed
• [Journal Article] Efficacy of plasma exchange for antineutrophil cytoplasmic antibody-associated systemic vasculitis: a systematic review and meta-analysis (2021)
  • Author(s): Yamada Yosuke、Harada Makoto、Hara Yuuta、Iwabuchi Ryohei、Hashimoto Koji、Yamamoto Shuhei、Kamijo Yuji
  • Journal Title: Arthritis Research & Therapy Volume: 23 Issue: 1 Pages: 28-28
  • DOI: 10.1186/s13075-021-02415-z
  • Peer Reviewed / Open Access
• [Journal Article] Prevalence and prognostic value of the coexistence of anaemia and frailty in older patients with heart failure (2020)
  • Author(s): Tanaka, S. Kamiya, K. Saito, H. Saito, K. Ogasahara, Y. Maekawa, E. Konishi, M. Kitai, T. Iwata, K. Jujo, K. Wada, H. Kasai, T. Hamazaki, N. Nozaki, K. Nagamatsu, H. Ozawa, T. Izawa, K. Yamamoto, S. Aizawa, N. Wakaume, K. Oka, K. Momomura, S. I. Kagiyama, N. Matsue, Y
  • Journal Title: ESC Heart Failure Volume: 8 Issue: 1 Pages: 625-633
  • DOI: 10.1002/ehf2.13140
  • Peer Reviewed / Open Access
• [Journal Article] Impact of sarcopenia on prognosis in patients with heart failure with reduced and preserved ejection fraction (2020)
  • Author(s): Konishi M、Kagiyama N、Kamiya K、Saito H、Saito K、Ogasahara Y、Maekawa E、Misumi T、Kitai T、Iwata K、Jujo K、Wada H、Kasai T、Nagamatsu H、Ozawa T、Izawa K、Yamamoto S、Aizawa N、Makino A、Oka K、Momomura S、Matsue Y
  • Journal Title: European Journal of Preventive Cardiology Volume: 117 Issue: 9 Pages: 1022-1029
  • DOI: 10.1093/eurjpc/zwaa117
  • Peer Reviewed / Open Access
• [Journal Article] Effects of exercise on kidney and physical function in patients with non-dialysis chronic kidney disease: a systematic review and meta-analysis (2020)
  • Author(s): Nakamura Keisuke、Sasaki Tomohiro、Yamamoto Shuhei、Hayashi Hiroto、Ako Shinji、Tanaka Yuu
  • Journal Title: Scientific Reports Volume: 10 Issue: 1 Pages: 18195-18195
  • DOI: 10.1038/s41598-020-75405-x
  • Peer Reviewed / Open Access
• [Journal Article] Impact of physical performance on prognosis among patients with heart failure: Systematic review and meta-analysis (2020)
  • Author(s): Yamamoto Shuhei、Yamaga Takayoshi、Nishie Kenichi、Sakai Yasunari、ishida Takaaki、Oka Keiko、Ikegami Shota、Horiuchi Hiroshi
  • Journal Title: Journal of Cardiology Volume: 76 Issue: 2 Pages: 139-146
  • DOI: 10.1016/j.jjcc.2020.02.022
  • Peer Reviewed
• [Journal Article] Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE‐HF cohort study (2020)
  • Author(s): Matsue, Y. Kamiya, K. Saito, H. Saito, K. Ogasahara, Y. Maekawa, E. Konishi, M. Kitai, T. Iwata, K. Jujo, K. Wada, H. Kasai, T. Nagamatsu, H. Ozawa, T. Izawa, K. Yamamoto, S. Aizawa, N. Yonezawa, R. Oka, K. Momomura, S. I. Kagiyama, N
  • Journal Title: European Journal of Heart Failure Volume: 22 Issue: 11 Pages: 2112-2119
  • DOI: 10.1002/ejhf.1926
  • Peer Reviewed / Open Access
• [Journal Article] Factors causing delayed start of oral intake in patients after acute cardiovascular surgery (2019)
  • Author(s): Oguchi Natsuko、Yamamoto Shuhei、Terashima Satsuki、Mizutani Hitomi、Okamoto Rie、Yoshimura Yasuo
  • Journal Title: Journal of the Japanese Society of Intensive Care Medicine Volume: 26 Issue: 3 Pages: 163-169
  • DOI: 10.3918/jsicm.26_163
  • NAID: 130007641288
  • ISSN: 1340-7988, 1882-966X
  • Year and Date: 2019-05-01
  • Peer Reviewed
• [Journal Article] Impact of inpatient cardiac rehabilitation on Barthel Index score and prognosis in patients with acute decompensated heart failure (2019)
  • Author(s): Motoki Hirohiko、Nishimura Musashi、Kanai Masafumi、Kimura Kazuhiro、Minamisawa Masatoshi、Yamamoto Shuhei、Saigusa Tatsuya、Ebisawa Soichiro、Okada Ayako、Kuwahara Koichiro
  • Journal Title: International Journal of Cardiology Volume: 293 Pages: 125-130
  • DOI: 10.1016/j.ijcard.2019.06.071
  • Peer Reviewed
• [Journal Article] Peripherally acting μ‐opioid antagonist for the treatment of opioid‐induced constipation: Systematic review and meta‐analysis (2019)
  • Author(s): Nishie Kenichi、Yamamoto Shuhei、Yamaga Takayoshi、Horigome Naoto、Hanaoka Masayuki
  • Journal Title: Journal of Gastroenterology and Hepatology Volume: 34 Issue: 5 Pages: 818-829
  • DOI: 10.1111/jgh.14586
  • Peer Reviewed
• [Journal Article] 心臓血管外科術後の肺炎と嚥下機能の関係 (2019)
  • Author(s): 小口和津子、山本周平、寺島さつき、岡本梨江、吉村康夫
  • Journal Title: 心臓リハビリテーション Volume: 印刷中
  • Peer Reviewed
• [Journal Article] 集中治療領域でのリハビリテーションのエビデンスと介入方法 (2019)
  • Author(s): 山本周平
  • Journal Title: 秋田理学療法 Volume: 印刷中
  • NAID: 40021878014
• [Journal Article] 報告 代謝当量は安静時ならびに運動時の心拍数から推定可能か? (2018)
  • Author(s): 山本 周平、石田 昂彬、三澤 加代子、大平 雅美、矢嶋 史恵、樋口 智子、山崎 佐枝子、吉村 康夫
  • Journal Title: 理学療法ジャーナル Volume: 52 Issue: 4 Pages: 372-377
  • DOI: 10.11477/mf.1551201178
  • ISSN: 0915-0552, 1882-1359
  • Year and Date: 2018-04-15
  • Peer Reviewed
• [Journal Article] PT・OT・STの時間外労働削減のための取り組みと成果 (2018)
  • Author(s): 井戸芳和、寺島さつき、山鹿隆義、西村輝、大津勇介、山本周平、荻無里亜希、川崎桂子、吉村康夫
  • Journal Title: 国立大学リハビリテーション療法士学術大会誌 Volume: 39 Pages: 103-105
  • NAID: 40021903369
  • Peer Reviewed
• [Journal Article] The simple method for predicting metabolic equivalents using heart rate in patients with cardiovascular disease (2018)
  • Author(s): Yamamoto Shuhei、Ishida Takaaki、Misawa Kayoko、Ohira Masayoshi、Yajima Fumie、Higuchi Satoko、Yamasaki Saeko、Yoshimura Yasuo
  • Journal Title: IJC Heart & Vasculature Volume: 19 Pages: 88-89
  • DOI: 10.1016/j.ijcha.2018.05.005
  • Peer Reviewed
• [Journal Article] Exercise-based cardiac rehabilitation for people with implantable ventricular assist devices (2018)
  • Author(s): Yamamoto Shuhei、Hotta Kazuki、Ota Erika、Matsunaga Atsuhiko、Mori Rintaro
  • Journal Title: Cochrane Database of Systematic Reviews Volume: 9
  • DOI: 10.1002/14651858.cd012222.pub2
  • Peer Reviewed
• [Journal Article] Swallowing Muscle Dysfunction and Residual Factor of Dysphagia with Community- Acquired Pneumonia in the Elderly (2018)
  • Author(s): Y Sakai、T Yamaga、S Yamamoto、M Ohira、Y Yokokawa、T Sakamoto、M Kikuchi、Y Yoshimura
  • Journal Title: Journal of Pulmonary & Respiratory Medicine Volume: 08 Issue: 03 Pages: 462-462
  • DOI: 10.4172/2161-105x.1000462
  • Peer Reviewed
• [Presentation] 急性大動脈解離患者における術前のフレイル評価と生命予後の関係 (2019)
  • Author(s): 山本周平、五味渕俊仁、酒井康成、石田昂彬、三澤加代子、岡田健次
  • Organizer: 第83回日本循環器学会学術集会
• [Presentation] Prevalence and prognostic value of physical and social frailty in geriatric patients hospitalized for heart failure (FRAGILE-HF) (2018)
  • Author(s): Kagiyama N, Kamiya K, Saito H, Saito K, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Jujo K, Wada H, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Yonezawa R, Oka K, Momomura S, Matsue Y
  • Organizer: The 82th Annual Scientific Meeting of Japanese Circulation Society
• [Presentation] 急性大動脈解離患者の術前フレイルと生命予後の関係 (2018)
  • Author(s): 山本周平、五味渕俊仁、酒井康成、石田昂彬、三澤加代子、大平雅美、岡田健次
  • Organizer: 第24回日本心臓リハビリテーション学会
• [Presentation] 術前フレイルは急性大動脈解離患者の治療経過を遅延させる (2018)
  • Author(s): 酒井康成、五味渕俊仁、山本周平、石田昂彬、三澤加代子、大平雅美、岡田健次
  • Organizer: 第2回日本呼吸・心血管・糖尿病理学療法学会
• [Presentation] 間質性肺炎患者における筋厚測定の信頼性および妥当性の検討 (2018)
  • Author(s): 保科美穂，山本周平，酒井康成，川内翔平
  • Organizer: 第2回日本呼吸・心血管・糖尿病理学療法学会
• [Book] 極める循環器理学療法 : 循環器病を有する患者の障害像に挑む (2020)
  • Author(s): 斉藤, 秀之, 加藤, 浩, 木村, 雅彦
  • Total Pages: 7295
  • Publisher: 文光堂
  • ISBN: 9784830645822
• [Book] 循環器リハビリテーションの理論と技術 (2020)
  • Author(s): 増田 卓、松永 篤彦
  • Total Pages: 472
  • Publisher: メジカルビュー社
  • ISBN: 9784758319423
• [Book] 運動療法エビデンスレビュー : 臨床・研究に役立つ評価指標・基準値・介入のエビデンスをこの一冊に凝縮 (2018)
  • Author(s): 神谷 健太郎、松永 篤彦
  • Total Pages: 401
  • Publisher: 文光堂
  • ISBN: 9784830645655