Pulignano Giovanni, Del Sindaco Donatella, Tinti Maria D, Di Lenarda Andrea, Alunni Gianfranco, Senni Michele, Tarantini Luigi, Cioffi Giovanni, Barbati Giulia, Minardi Giovanni, Murrone Adriano, Ciurluini Paola, Uguccioni Massimo
aHeart Failure Clinic, Cardiology 1/CCU, San Camillo Hospital bCardiology Unit, Nuovo Regina Margherita Hospital, Rome cCardiovascular Center and University, Trieste dHeart Failure Unit, S. Maria della Misericordia Hospital, Perugia eCardiology Unit, S. Giovanni XXIII Hospital, Bergamo fHeart Failure Clinic, San Martino Hospital, Belluno gDivision of Cardiology, Villa Bianca Hospital, Trento hClinical Psychology Unit, San Camillo Hospital, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2016 Aug;17(8):616-23. doi: 10.2459/JCM.0000000000000366.
Aim of the study was to prospectively assess the relation between atrial fibrillation, cognitive impairment, frailty and disability in older patients with chronic heart failure .
Three hundred thirty-one ambulatory community-living patients aged 70 years and older (mean 78 ± 6; range 70-93; 43% women) in stable conditions and optimized therapy were enrolled in seven heart failure cardiology clinics. Cognitive impairment was defined by a corrected Mini Mental State Examination score less than 24. Gait speed was used as marker of frailty and measured on a 4 m distance at usual pace.
Ninety-eight patients (30%) were on atrial fibrillation at enrolment and 20 (6%) had a history of paroxysmal/persistent atrial fibrillation. Patients with atrial fibrillation were more frequently women with severe valvular disease, preserved left ventricular ejection fraction and less frequently on beta-blockers. At multivariable analyses, atrial fibrillation emerged as independently related to cognitive impairment [odds ratio (OR) 1.909 (1.072-3.397); P = 0.028], as well as to reduced gait speed [OR 4.366 (2.104-9.060); P < 0.001]. Furthermore, atrial fibrillation was significantly associated with disability in either basic or instrumental activities of daily living. No differences were found in mortality and morbidity.
Among patients with chronic heart failure, those with atrial fibrillation present a high prevalence of frailty, cognitive impairment and disability. The hypothetical mechanisms by which atrial fibrillation and heart failure may affect these conditions are multiple and further studies are warranted. However, screening for these variables in clinical practice is simple and inexpensive and may allow better strategies for intervention in this high-risk population.
本研究旨在前瞻性评估老年慢性心力衰竭患者心房颤动、认知障碍、衰弱与残疾之间的关系。
在七家心力衰竭心脏病诊所招募了331名年龄在70岁及以上（平均78±6岁；范围70 - 93岁；43%为女性）、病情稳定且接受优化治疗的社区门诊患者。认知障碍定义为校正后的简易精神状态检查表得分低于24分。步速用作衰弱的指标，以平常步伐在4米距离上进行测量。
98名患者（30%）在入组时患有心房颤动，20名患者（6%）有阵发性/持续性心房颤动病史。患有心房颤动的患者女性更多，患有严重瓣膜疾病，左心室射血分数保留，使用β受体阻滞剂的频率较低。在多变量分析中，心房颤动与认知障碍独立相关[比值比（OR）1.909（1.072 - 3.397）；P = 0.028]，也与步速降低相关[OR 4.366（2.104 - 9.060）；P < 0.001]。此外，心房颤动与日常生活的基本或工具性活动中的残疾显著相关。在死亡率和发病率方面未发现差异。
在慢性心力衰竭患者中，患有心房颤动的患者衰弱、认知障碍和残疾的患病率较高。心房颤动和心力衰竭可能影响这些状况的假设机制是多方面的，需要进一步研究。然而，在临床实践中筛查这些变量简单且成本低廉，可能有助于为这一高危人群制定更好的干预策略。
