Gyalai-Korpos Istvan, Ancusa Oana, Dragomir Tiberiu, Tomescu Mirela Cleopatra, Marincu Iosif
University of Medicine and Pharmacy, Timisoara, Romania ; Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
University of Medicine and Pharmacy, Timisoara, Romania ; Department of Epidemiology and Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
Clin Interv Aging. 2015 Mar 11;10:561-8. doi: 10.2147/CIA.S79569. eCollection 2015.
The purpose of this prospective study was to identify factors associated with prolonged hospitalization, readmission, and death in elderly patients presenting heart failure with reduced ejection fraction.
All consecutive patients aged ≥65 years discharged with a diagnosis of acute new-onset heart failure and a left ventricular ejection fraction (LVEF) ≤45% were included and followed up for 1 year. The variables associated with outcomes were analyzed in univariate and multivariate logistic regression. For the independent predictors identified by multivariate analysis, receiver operating characteristic (ROC) analysis was performed.
A total of 71 patients were included in the study. The patient mean age was 72.5 years, 50% were female, and the mean LVEF was 31.25%±5.76%. In all, 34 (48%) patients experienced prolonged hospitalization, and this was independently associated with patients who were living in a rural area (P=0.005), those with a New York Heart Association functional class of 4 (P<0.001), the presence of comorbidities (P=0.023), chronic obstructive pulmonary disease (COPD) infectious exacerbation (P<0.001), and chronic kidney disease (P=0.025). In the multivariate analysis, only COPD infectious exacerbation was independently associated with prolonged hospitalization (P=0.003). A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular causes and seven (10%) had noncardiovascular causes. The following independent variables associated with rehospitalizations were outlined in the univariate analysis: infections (P<0.020); COPD infectious exacerbation (P=0.015); one or more comorbidity (P<0.0001); and prolonged baseline hospitalization (P<0.0001). During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01). The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths. The only independent predictive variable for mortality was a New York Heart Association NYHA functional class 4 at baseline hospitalization (P=0.001).
Elderly patients are at high risk for prolonged hospitalization, readmission, and death following a first hospitalization for heart failure with reduced ejection fraction. The most powerful predictors for outcomes are the severity of heart failure, the presence of comorbidities, and prolonged hospitalization at baseline.
本前瞻性研究旨在确定射血分数降低的老年心力衰竭患者长期住院、再入院和死亡的相关因素。
纳入所有年龄≥65岁、出院诊断为急性新发心力衰竭且左心室射血分数（LVEF）≤45%的连续患者，并进行1年随访。对与结局相关的变量进行单因素和多因素逻辑回归分析。对多因素分析确定的独立预测因素进行受试者工作特征（ROC）分析。
本研究共纳入71例患者。患者平均年龄为72.5岁，50%为女性，平均LVEF为31.25%±5.76%。共有34例（48%）患者住院时间延长，这与居住在农村地区的患者（P=0.005）、纽约心脏协会心功能分级为4级的患者（P<0.001）、合并症的存在（P=0.023）、慢性阻塞性肺疾病（COPD）感染加重（P<0.001）以及慢性肾脏病（P=0.025）独立相关。在多因素分析中，只有COPD感染加重与住院时间延长独立相关（P=0.003）。在1年随访期间，共有19例（27%）患者再次入院，其中12例（17%）为心血管原因，7例（10%）为非心血管原因。单因素分析列出了以下与再次住院相关的独立变量：感染（P<0.020）；COPD感染加重（P=0.015）；一种或多种合并症（P<0.0001）；以及基线住院时间延长（P<0.0001）。在多因素分析中，发现再次入院的独立预测因素是合并症的存在（P<0.001）和基线住院时间延长（P<0.01）。1年死亡率为9.8%，心血管死亡（5.6%）和非心血管死亡（4.2%）之间无显著差异。死亡率的唯一独立预测变量是基线住院时纽约心脏协会（NYHA）心功能分级为4级（P=0.001）。
射血分数降低的老年心力衰竭患者首次住院后长期住院、再入院和死亡的风险较高。结局的最有力预测因素是心力衰竭的严重程度、合并症的存在以及基线住院时间延长。
