Jha Sunita R, Hannu Malin K, Gore Keren, Chang Sungwon, Newton Phillip, Wilhelm Kay, Hayward Christopher S, Jabbour Andrew, Kotlyar Eugene, Keogh Anne, Dhital Kumud, Granger Emily, Jansz Paul, Spratt Phillip M, Montgomery Elyn, Harkess Michelle, Tunicliff Peta, Davidson Patricia M, Macdonald Peter S
Heart Transplant Program, St Vincent's Hospital; Centre for Cardiovascular and Chronic Care, Faculty Health, University of Technology Sydney.
Heart Transplant Program, St Vincent's Hospital; Department of Occupational Therapy.
J Heart Lung Transplant. 2016 Sep;35(9):1092-100. doi: 10.1016/j.healun.2016.04.008. Epub 2016 May 6.
The aim of this study was to identify whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty provides better outcome prediction in patients with advanced heart failure referred for heart transplantation (HT).
Beginning in March 2013, all patients with advanced heart failure referred to our Transplant Unit have undergone a physical frailty assessment using the Fried frailty phenotype. Cognition was assessed with the Montreal Cognitive Assessment and depression with the Depression in Medical Illness questionnaire. We assessed the value of 4 composite frailty measures: physical frailty (PF ≥ 3 of 5 = frailty), "cognitive frailty" (CogF ≥ 3 of 6 = frail), "depressive frailty" (DepF ≥ 3 of 6 = frail), and "cognitive-depressive frailty" (ComF ≥ 3 of 7 = frail) in predicting outcomes.
Frailty was assessed in 156 patients (109 men, 47 women), aged 53 ± 13 years, and with a left ventricular ejection fraction of 27% ± 14%. Inclusion of cognitive impairment or depression in the definition of frailty increased the proportion classified as frail from 33% using PF to 42% using ComF. During follow-up, 28 patients died before ventricular assist device implantation or HT. Frailty was associated with significantly lower ventricular assist device- and HT-free survival, with CogF best capturing early mortality: 12-month survival for non-frail and frail cohorts was 81% ± 5% vs 58% ± 10% (p < 0.02) using PF and 85% ± 5% vs 56% ± 9% (p < 0.002) using CogF. Combining the Depression in Medical Illness score with PF or CogF did not strengthen the relationship between frailty and mortality.
The addition of cognitive impairment to the assessment of PF strengthened its capacity to identify advanced heart failure patients referred for HT who are at high risk of early death.
本研究的目的是确定在对因晚期心力衰竭而转诊接受心脏移植（HT）的患者进行身体虚弱评估时，加入认知障碍、抑郁或两者，是否能更好地预测预后。
从2013年3月开始，所有转诊至我们移植科的晚期心力衰竭患者均采用弗里德虚弱表型进行身体虚弱评估。使用蒙特利尔认知评估量表评估认知功能，使用疾病中的抑郁问卷评估抑郁情况。我们评估了4种综合虚弱指标的价值：身体虚弱（PF≥5项中的3项=虚弱）、“认知虚弱”（CogF≥6项中的3项=虚弱）、“抑郁性虚弱”（DepF≥6项中的3项=虚弱）和“认知-抑郁性虚弱”（ComF≥7项中的3项=虚弱）对预后的预测作用。
对156例患者（109例男性，47例女性）进行了虚弱评估，患者年龄为53±13岁，左心室射血分数为27%±14%。在虚弱的定义中加入认知障碍或抑郁，使被归类为虚弱的比例从使用PF时的33%增加到使用ComF时的42%。在随访期间，28例患者在植入心室辅助装置或进行心脏移植前死亡。虚弱与显著更低的无心室辅助装置和心脏移植生存率相关，CogF最能捕捉早期死亡率：使用PF时，非虚弱和虚弱队列的12个月生存率分别为81%±5%和58%±10%（p<0.02），使用CogF时分别为85%±5%和56%±9%（p<0.002）。将疾病中的抑郁评分与PF或CogF相结合，并未加强虚弱与死亡率之间的关系。
在身体虚弱评估中加入认知障碍，增强了其识别因晚期心力衰竭而转诊接受心脏移植且有早期死亡高风险患者的能力。
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