Martín-Sánchez Francisco Javier, Rodríguez-Adrada Esther, Vidan Maria Teresa, Llopis García Guillermo, González Del Castillo Juan, Rizzi Miguel Alberto, Alquezar Aitor, Piñera Pascual, Lázaro Aragues Paula, Llorens Pere, Herrero Pablo, Jacob Javier, Gil Víctor, Fernández Cristina, Bueno Héctor, Miró Òscar
Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.
Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.
Am J Cardiol. 2017 Oct 1;120(7):1151-1157. doi: 10.1016/j.amjcard.2017.06.059. Epub 2017 Jul 14.
The objectives were to determine the impact of frailty and disability on 30-day mortality and whether the addition of these variables to HFRSS EFFECT risk score (FBI-EFFECT model) improves the short-term mortality predictive capacity of both HFRSS EFFECT and BI-EFFECT models in older patients with acute decompensated heart failure (ADHF) atended in the emergency department. We performed a retrospective analysis of OAK Registry including all consecutive patients ≥65 years old with ADHF attended in 3 Spanish emergency departments over 4 months. FBI-EFFECT model was developed by adjusting probabilities of HFRSS EFFECT risk categories according to the 6 groups (G1: non frail, no or mildly dependent; G2: frail, no or mildly dependent; G3: non frail, moderately dependent; G4: frail, moderately dependent; G5: severely dependent; G6: very severely dependent).We included 596 patients (mean age: 83 [SD7]; 61.2% females). The 30-day mortality was 11.6% with statistically significant differences in the 6 groups (p < 0.001). After adjusting for HFRSS EFFECT risk categories, we observed a progressive increase in hazard ratios from groups G2 to G6 compared with G1 (reference). FBI-EFFECT had a better prognostic accuracy than did HFRSS EFFECT (log-rank p < 0.001; Net Reclassification Improvement [NRI] = 0.355; p < 0.001; Integrated Discrimination Improvement [IDI] = 0.052; p ;< 0.001) and BI-EFFECT (log-rank p = 0.067; NRI = 0.210; p = 0.033; IDI = 0.017; p = 0.026). In conclusion, severe disability and frailty in patients with moderate disability are associated with 30-day mortality in ADHF, providing additional value to HFRSS EFFECT model in predicting short-term prognosis and establishing a care plan.
本研究旨在确定衰弱和残疾对30天死亡率的影响，以及将这些变量添加到HFRSS EFFECT风险评分（FBI-EFFECT模型）中是否能提高HFRSS EFFECT和BI-EFFECT模型对急诊科收治的急性失代偿性心力衰竭（ADHF）老年患者短期死亡率的预测能力。我们对OAK注册研究进行了回顾性分析，纳入了4个月内西班牙3个急诊科收治的所有连续≥65岁的ADHF患者。FBI-EFFECT模型是通过根据6组情况（G1：非衰弱，无或轻度依赖；G2：衰弱，无或轻度依赖；G3：非衰弱，中度依赖；G4：衰弱，中度依赖；G5：重度依赖；G6：极重度依赖）调整HFRSS EFFECT风险类别的概率而开发的。我们纳入了596例患者（平均年龄：83[标准差7]；61.2%为女性）。30天死亡率为11.6%，6组之间存在统计学显著差异（p<0.001）。在调整HFRSS EFFECT风险类别后，我们观察到与G1组（参照组）相比，从G2组到G6组的风险比逐渐增加。FBI-EFFECT的预后准确性优于HFRSS EFFECT（对数秩检验p<0.001；净重新分类改善[NRI]=0.355；p<0.001；综合判别改善[IDI]=0.052；p<0.001）和BI-EFFECT（对数秩检验p=0.067；NRI=0.210；p=0.033；IDI=..017；p=0.026）。总之，ADHF患者中的严重残疾和中度残疾患者的衰弱与30天死亡率相关，这为HFRSS EFFECT模型在预测短期预后和制定护理计划方面提供了额外价值。
