Lupón Josep, González Beatriz, Santaeugenia Sebastián, Altimir Salvador, Urrutia Agustín, Más Dolores, Díez Crisanto, Pascual Teresa, Cano Lucía, Valle Vicente
Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Rev Esp Cardiol. 2008 Aug;61(8):835-42.
Heart failure patients have high levels of frailty and dependence. Our aim was to determine the impact of frailty and depressive symptoms on the 1-year mortality rate and the rate of hospitalization for heart failure during a follow-up period of 1 year.
All patients underwent geriatric evaluation, and frailty and depressive symptoms were identified. The study included 622 patients (72.5% male; median age, 68 years; 92% in New York Heart Association class II or III; and median ejection fraction, 30%).
During follow-up, 60 patients (9.5%) died and 101 (16.2%) were hospitalized for heart failure. Overall, 39.9% of patients exhibited frailty, while 25.2% had depressive symptoms. There were significant associations between mortality at 1 year and the presence of frailty (16.9% vs. 4.8%; P< .001) and depressive symptoms (15.3% vs. 7.7%; P=.006). There was also a significant relationship between heart failure hospitalization and the presence of frailty (20.5% vs. 13.3%; P=.01). No relationship was found between heart failure hospitalization and depressive symptoms. Frailty was an independent predictor of mortality but not of hospitalization.
Univariate analysis demonstrated significant relationships between frailty and depressive symptoms and mortality at 1 year. In addition, there was a significant relationship between frailty and the need for heart failure hospitalization. However, only frailty showed prognostic value to predict mortality, which was independent of other variables strongly associated to outcome.
心力衰竭患者存在高度的虚弱和依赖状况。我们的目的是确定虚弱和抑郁症状对1年死亡率以及1年随访期内心力衰竭住院率的影响。
所有患者均接受了老年医学评估，并确定了虚弱和抑郁症状。该研究纳入了622例患者（男性占72.5%；中位年龄68岁；92%为纽约心脏协会II级或III级；中位射血分数为30%）。
在随访期间，60例患者（9.5%）死亡，101例（16.2%）因心力衰竭住院。总体而言，39.9%的患者表现出虚弱，而25.2%的患者有抑郁症状。1年死亡率与虚弱的存在（16.9%对4.8%；P<0.001）以及抑郁症状（15.3%对7.7%；P = 0.006）之间存在显著关联。心力衰竭住院与虚弱的存在之间也存在显著关系（20.5%对13.3%；P = 0.01）。未发现心力衰竭住院与抑郁症状之间存在关联。虚弱是死亡率的独立预测因素，但不是住院率的独立预测因素。
单因素分析表明，虚弱和抑郁症状与1年死亡率之间存在显著关系。此外，虚弱与心力衰竭住院需求之间存在显著关系。然而，只有虚弱显示出预测死亡率的预后价值，且该价值独立于其他与结局密切相关的变量。
