Department of Internal Medicine, Section of General Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8093, USA.
J Am Coll Cardiol. 2010 Jan 26;55(4):309-16. doi: 10.1016/j.jacc.2009.07.066.
This study was designed to develop models for short- (30-day) and long- (5-year) term mortality after heart failure (HF) hospitalization that include geriatric conditions, specifically mobility disability and dementia, to determine whether these conditions emerge as strong and independent risk factors.
Although 80% of patients with HF are 65 years of age or older, no large studies have focused on the prognostic importance of geriatric conditions.
We analyzed medical record data from a national sample of Medicare beneficiaries hospitalized for HF. To identify independent predictors of mortality, we performed stepwise selection in multivariable logistic regression models. We used net reclassification improvement to assess the incremental benefit of adding geriatric conditions to a model containing traditional risk factors for mortality.
The mean age of patients included in the analysis was 80 years; 59% were women, 13% were nonwhite, 10% had dementia, and 39% had mobility disability. Mortality rates were 9.8% at 30 days and 74.7% at 5 years. Twenty-one variables were considered for inclusion in the final multivariable model. Dementia and mobility disability were among the top predictors of short- and long-term mortality, with among the top 6 largest absolute standardized estimates in the final model for 30-day mortality, and among the top 7 largest standardized estimates for 5-year mortality. The net reclassification improvement when geriatric conditions were added to traditional factors was 5.1% at 30 days and 4.2% at 5 years.
Geriatric conditions are strongly and independently associated with short- and long-term mortality among older patients with HF.
本研究旨在开发心力衰竭（HF）住院后短期（30 天）和长期（5 年）死亡率模型，该模型包含老年状况，特别是活动能力障碍和痴呆症，以确定这些状况是否成为强有力的独立危险因素。
尽管 80%的 HF 患者年龄在 65 岁及以上，但尚无大型研究关注老年状况对预后的重要性。
我们分析了来自 Medicare 受益人的全国性样本中因 HF 住院的患者的病历数据。为了确定死亡率的独立预测因素，我们在多变量逻辑回归模型中进行了逐步选择。我们使用净重新分类改善来评估将老年状况添加到包含死亡率传统危险因素的模型中是否会带来额外的益处。
分析中患者的平均年龄为 80 岁；59%为女性，13%为非裔美国人，10%患有痴呆症，39%有活动能力障碍。30 天死亡率为 9.8%，5 年死亡率为 74.7%。有 21 个变量被认为可以纳入最终的多变量模型。痴呆症和活动能力障碍是短期和长期死亡率的主要预测因素之一，在 30 天死亡率的最终模型中，其绝对标准化估计值排在前 6 位，在 5 年死亡率的最终模型中，其标准化估计值排在前 7 位。当将老年状况添加到传统因素时，净重新分类改善在 30 天时为 5.1%，在 5 年时为 4.2%。
老年状况与老年 HF 患者的短期和长期死亡率密切相关，且独立相关。
