Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Int J Cardiol. 2018 Mar 1;254:182-188. doi: 10.1016/j.ijcard.2017.10.104. Epub 2018 Jan 28.
Dependence for basic activities of the daily living (ADL) relates to adverse outcomes in elderly acute heart failure (AHF) patients.
We evaluated patients ≥75years admitted because of AHF, divided according to preadmission Barthel Index (BI) category: severe (BI 0-60), moderate (BI 61-90) and slight dependence or independence for basic ADL (BI 91-100). We compared their baseline characteristics and used logistic regression models to determine whether a BI≤60 confers higher one-year mortality risk.
We included 2195 patients, mean age 83years; 57% women, Charlson Index 3, 65% with preserved left ventricular ejection fraction. Their median preadmission BI was 90 (65-100); 21.7% had BI≤60. Patients with BI≤60 were older, more often females, with higher comorbid and cognitive burden and more likely to be institutionalized. 560 patients (26%) died within the follow-up period. A preadmission BI≤60 was significantly associated with higher risk of 12-month mortality (HR 1.42, 95% CI 1.14-1.77) together with male sex (1.27, 1.04-1.54), valve disease (1.49, 1.20-1.83), worse preadmission NYHA class (1.44, 1.20-1.73), stage IV chronic kidney disease (1.70, 1.35-2.15), pulmonary edema (1.33, 1.01-1.76), no family support (1.47, 1.06-2.06), and higher Charlson Comorbidity Index (1.09, CI 1.05-1.13) and Pfeiffer cognitive screening questionnaire scores (1.10, 1.05-1.14).
Among elderly AHF patients, the presence of severe (BI≤60) preadmission dependence for basic ADL confers a significant and independent risk of one-year post-discharge mortality.
日常生活活动（ADL）依赖与老年急性心力衰竭（AHF）患者的不良结局相关。
我们评估了因 AHF 入院的年龄≥75 岁的患者，根据入院前 Barthel 指数（BI）分类：严重（BI 0-60）、中度（BI 61-90）和轻度依赖或独立进行基本 ADL（BI 91-100）。我们比较了他们的基线特征，并使用逻辑回归模型来确定 BI≤60 是否会增加一年的死亡风险。
我们纳入了 2195 名患者，平均年龄 83 岁；57%为女性，Charlson 指数 3，65%左心室射血分数保留。他们入院前的中位 BI 为 90（65-100）；21.7%的患者 BI≤60。BI≤60 的患者年龄更大，女性更多，合并症和认知负担更高，更有可能被收容。2195 名患者中有 560 名（26%）在随访期间死亡。入院前 BI≤60 与 12 个月死亡率升高显著相关（HR 1.42，95%CI 1.14-1.77），同时与男性（1.27，1.04-1.54）、瓣膜病（1.49，1.20-1.83）、较差的入院前纽约心脏协会（NYHA）心功能分级（1.44，1.20-1.73）、慢性肾脏病 4 期（1.70，1.35-2.15）、肺水肿（1.33，1.01-1.76）、无家庭支持（1.47，1.06-2.06）和更高的 Charlson 合并症指数（1.09，CI 1.05-1.13）和 Pfeiffer 认知筛查问卷评分（1.10，1.05-1.14）相关。
在老年 AHF 患者中，严重（BI≤60）入院前 ADL 依赖与一年后出院后的死亡风险显著相关。
