Department of Geriatric Medicine, Elkerliek Hospital, Helmond, The Netherlands.
J Card Fail. 2012 Jan;18(1):47-52. doi: 10.1016/j.cardfail.2011.10.009. Epub 2011 Nov 25.
Elderly heart failure (HF) patients frequently have multiple comorbidities. The prognostic impact of combined comorbidities is poorly quantified in these patients. We assessed the impact of comorbidities on 3-year mortality in geriatric outpatients with newly diagnosed HF.
Of 93 geriatric outpatients with HF (mean age 82.7 years, 36.6% men), 52 patients (55.9%) died within 3 years after HF was diagnosed. Comorbidity was measured with the Charlson Comorbidity Index (CCI). Age- and gender-adjusted hazard ratio (HR) for 3-year mortality was 1.6 (95% confidence interval [CI] 0.9-3.2) for patients with 3-4 CCI points and 3.2 (95% CI 1.5-6.8) for those with >4 CCI points, compared with 1-2 CCI points. After adjustment for age, gender, left ventricular ejection fraction (LVEF), and N-terminal pro-B-type natriuretic peptide, CCI remained predictive of death (CCI 3-4: HR 1.5 (95% CI 0.7-2.9); CCI >4: HR 4.0 (95% CI 1.9-8.8)). In addition to age and gender, the c-statistics for CCI and LVEF were similar (0.63 [95% CI 0.55-0.70] and 0.64 [95% CI 0.56-0.72], respectively).
The majority of geriatric outpatients with new HF die within 3 years. Comorbidity, summarized in the CCI, is the strongest independent predictor of mortality.
老年心力衰竭（HF）患者常伴有多种合并症。这些患者的合并症对预后的影响尚未得到充分量化。我们评估了合并症对新诊断为 HF 的老年门诊患者 3 年死亡率的影响。
在 93 名患有 HF 的老年门诊患者中（平均年龄 82.7 岁，36.6%为男性），52 名患者（55.9%）在 HF 诊断后 3 年内死亡。采用 Charlson 合并症指数（CCI）来衡量合并症。与 1-2 个 CCI 点的患者相比，3-4 个 CCI 点和>4 个 CCI 点的患者 3 年死亡率的年龄和性别调整后的危险比（HR）分别为 1.6（95%置信区间[CI]，0.9-3.2）和 3.2（95%CI，1.5-6.8）。在调整年龄、性别、左心室射血分数（LVEF）和 N 末端 pro-B 型利钠肽后，CCI 仍然与死亡相关（CCI 3-4：HR 1.5（95%CI，0.7-2.9）；CCI>4：HR 4.0（95%CI，1.9-8.8））。除年龄和性别外，CCI 和 LVEF 的 C 统计量相似（0.63[95%CI，0.55-0.70]和 0.64[95%CI，0.56-0.72]）。
大多数新诊断为 HF 的老年门诊患者在 3 年内死亡。CCI 总结的合并症是死亡率的最强独立预测因素。
