Roig Thaïs, Márquez Miguel Ángel, Hernández Esmeralda, Pineda Ingrid, Sabartés Olga, Miralles Ramón, Inzitari Marco
Servicio de Geriatría, Parc Sanitari Pere Virgili, Barcelona, España.
Rev Esp Geriatr Gerontol. 2013 Nov-Dec;48(6):254-8. doi: 10.1016/j.regg.2013.07.001. Epub 2013 Oct 5.
Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF.
Prospective study of 101 patients (mean age, 85.9 ± 6.3 years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes.
In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI]=1.03 [1.01-1.06]; P=.040) and higher number of re-admissions (OR [95%CI]=3.53 [1.19-10.44]; P=.023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI]=0.15 [0.04-0.59]; P=.007).
Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF.
心力衰竭（HF）在老年人中非常普遍，且与高死亡率相关。预测HF的结局以及识别晚期患者很困难。本研究旨在确定老年评估变量以及与老年HF患者一年死亡风险增加相关的其他临床变量。
对2006年入住急性老年科、主要诊断为HF的101例患者（平均年龄85.9±6.3岁，81%为女性）进行前瞻性研究。我们记录了：人口统计学数据、易患心脏病、加重的主要诱因、合并症、出院时的处方数量和HF的具体治疗、平均住院时间、再入院情况以及出院后一年的死亡率。老年评估包括：基本（巴氏指数）和工具性（Lawton指数）日常生活活动能力障碍、认知功能（Pfeiffer测试）、合并症（Charlson指数）以及老年综合征。
在多变量逻辑回归模型中，既往功能障碍（较低的巴氏指数）（比值比[95%置信区间]=1.03[1.01 - 1.06]；P = 0.040）和较高的再入院次数（比值比[95%置信区间]=3.53[1.19 - 10.44]；P = 0.023）与一年死亡率相关。女性具有保护作用（比值比[95%置信区间]=0.15[0.04 - 0.59]；P = 0.007）。
日常生活基本活动能力障碍和再入院与老年患者一年死亡率增加相关，而女性具有保护作用。如果在进一步研究中得到证实，这些数据可能会强化对老年HF患者进行系统全面老年评估的必要性。
